ARTICLE IN PRESSJoumnal of the Society for Cardiovascular Angiography Interventions xxx (xxxx)xxxJSCAIJSCAIThe official joumal of the Society forCardiovascular Angiography&Standards and GuidelinesSCAl Expert Consensus Statement on Management of In-Stent Restenosisand Stent ThrombosisLloyd W.Klein,MD,MSCAI,Sandeep Nathan,MD,MSc,FSCAI,Akiko Maehara,MDFSCAI,John Messenger,MD,SCAI,Gary S.Mintz,MD,Ziad A.Ali,MD,DPhil,FSCAIJennifer Rymer,MD,FSCAI9,Yader Sandoval,MD,FSCAI,Karim Al-Azizi,MD,FSCAlRoxana Mehran,MD,MSCAI,Sunil V.Rao,MD,FSCAI,Amir Lotfi,MD,FRCP FSCAI..Division ofCardiology University of Califomi San Francisco,San Francisco,Califomia;Section of Cardiology Department of Medicine,University ofChicago,Chicago,Mllinois Center for Interventional Vascular Therapy,Division of Cardiology,Columbia Uriversity College of Physicians and Surgeans,NewYork,New York:Division of Cardiology University of Colorad Anschutz Medical Campus,Aurora Trials Center,Research Foundation,New York,New Yok;DeMatteis Cardiovascular institute,St.Francis Hospital Heart Center,Roslyn,New York;9 Division ofCardiology Duke University School of Medicine,Durham,North Carolina"Allina Health Minneapolis Heart institute,Minneapolis Minnesota;'Departmentof Interventional Cardiology,Baylor Scott White Health-The Heart Hospital,Plano,Texasi Zena and Michael A.Wiener Cardiovascular institute,MountSinai Medical Center,New York,New York;Division of Cardiology,NYU Langone Health System,New York,New York;'Division of Cardiology University ofMassachusetts Chan Medical School-Baystate,Springfield,MassachusettsABSTRACTStent failure remains the major drawback to the use of coronary stents as a revascularization strategy.Recent advances in imaging have substantiallyimproved our understanding of the mechanisms underlying these occurrences,which have in common numerous clinical risk factors and mechanical elements at the time ofstent implantation.In-stent restenosis remains a common clinical problem despite numerous improvements in-stent design and polymercoatings over the past 2 decades.It generates significant health care cost and is associated with an increased risk of death and rehospitalization.Stentthrombosis causes abrupt closure of the stented artery and therefore caries a high risk of myocardial infarction and death.This Society for CardiovascularAngiography Interventions(SCAl)Expert Consensus Statement suggests updated practical algorithmic approaches to in-stent restenosis and stentthrombosis.A pragmatic outline of assessment and management of patients presenting with stent failure is presented.A new SCAl classification that is time-sensitive with mechanistic implications of in-stent restenosis is proposed.Emphasis is placed on frequent use of intracoronary imaging and assessment oftiming to detemmine the precise etiology because that information is crucial to guide selection of the best treatment option.SCAl recommends image-guided coronary stenting at the time of initial implantation to
