This study investigates the pathology of coronary stenting in humans, focusing on the early and late responses to stent deployment. Histological analysis was performed on 55 stents in 35 coronary vessels from 32 patients, with a mean stent placement duration of 39±82 days. Early (≤11 days) after stenting, fibrin, platelets, and neutrophils were associated with stent struts, particularly in areas of medial damage or lipid core penetration. Chronic inflammation was also common at all time points. Neointimal growth was a key factor in long-term histological success, with increased growth correlating with larger stent size relative to the proximal reference lumen area. Stent oversizing and medial damage were associated with increased neointimal growth and restenosis. The study highlights the importance of avoiding severe arterial injury and optimizing stent deployment strategies to reduce the risk of in-stent restenosis.This study investigates the pathology of coronary stenting in humans, focusing on the early and late responses to stent deployment. Histological analysis was performed on 55 stents in 35 coronary vessels from 32 patients, with a mean stent placement duration of 39±82 days. Early (≤11 days) after stenting, fibrin, platelets, and neutrophils were associated with stent struts, particularly in areas of medial damage or lipid core penetration. Chronic inflammation was also common at all time points. Neointimal growth was a key factor in long-term histological success, with increased growth correlating with larger stent size relative to the proximal reference lumen area. Stent oversizing and medial damage were associated with increased neointimal growth and restenosis. The study highlights the importance of avoiding severe arterial injury and optimizing stent deployment strategies to reduce the risk of in-stent restenosis.