Intestinal ischemia and hypoxia can occur when the superior mesenteric artery (SMA) becomes narrowed or occluded, leading to insufficient blood perfusion. This condition can result in mucosal damage and ischemic necrosis of the intestinal tissue. Restoring blood flow and relieving luminal stenosis is crucial for preventing intestinal necrosis. In recent years, endovascular stent implantation has become one of the primary treatment modalities for SMA stenosis due to its minimally invasive nature compared to open surgical revascularization. It offers advantages such as shorter hospitalization, reduced risk of complications, and lower mortality rates. The procedure has demonstrated favorable short-term clinical outcomes and is consistently recommended in guidelines. However, as stent implantation has become more widely used, in-stent restenosis (ISR) has gained attention after SMA stent implantation. Studies have indicated that patients with SMA stenosis treated with stents are more likely to develop ISR than those who undergo open surgical revascularization. Therefore, managing patients after SMA stent implantation is essential, including maintaining medication therapy to achieve long-term stent patency, early identification and diagnosis of ISR through ultrasound and imaging examinations, and selecting appropriate timing for reintervention. Dual-function ultrasound (DUS) and computed tomography angiography (CTA) demonstrate high sensitivity and specificity for ISR diagnosis and have replaced digital subtraction angiography (DSA) as the preferred preoperative diagnostic and screening tools. Due to the severe consequences of SMA ischemic lesions, such as intestinal necrosis, timely intervention is crucial. Therefore, patients presenting with relevant clinical symptoms of ISR should undergo secondary surgery as soon as possible. The surgical approach can involve repeating endovascular angioplasty and/or stent implantation. For patients with recurring lesions or anatomical constraints that make repeat endovascular repair difficult, traditional open surgical procedures, such as SMA bypass surgery, can be considered a more durable option, particularly in high-risk patients. Here, the authors conduct a literature review on ISR following SMA stent implantation, aiming to summarize and consolidate the current knowledge on preventive strategies, diagnostic approaches, and treatment advancements for ISR.