Key result
Multilayer in-stent restenosis linked to ~45% higher 10-year TLR risk vs single-layer lesions.
Why the study?
Patients undergoing PCI for in-stent restenosis with multiple stent layers represent a complex subgroup, and the prognostic impact of multiple stent layers on long-term procedural and clinical outcomes remained unclear.
Does the presence of multiple stent layers (≥2 layers) compared to a single stent layer increase the risk of 10-year adverse clinical outcomes and recurrent target lesion revascularisation in patients undergoing PCI for in-stent restenosis?
Observational (n=402)
Does the presence of multiple stent layers (≥2 layers) compared to a single stent layer increase the risk of 10-year adverse clinical outcomes and recurrent target lesion revascularisation in patients undergoing PCI for in-stent restenosis?
In patients undergoing PCI for in-stent restenosis, having two or more stent layers is associated with a significantly higher 10-year risk of first and recurrent target lesion revascularisation, without increasing the risk of cardiac death or myocardial infarction.
Answers are grounded in this paper and cite their sources.
Multilayer ISR may warrant closer post-PCI surveillance; extends short-term observations to 10-year TLR but leaves optimal strategies open.
Background Patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) with multiple stent layers represent a complex subgroup. However, the prognostic impact of multiple stent layers on long-term procedural and clinical outcomes remains unclear. Objectives To evaluate the association of multilayer versus single-layer lesions with long-term clinical outcomes and recurrent TLR in patients undergoing PCI for ISR. Methods This post hoc analysis of a randomised trial included 402 patients who underwent PCI in 500 ISR lesions. Lesions were classified into two groups according to the number of stent layers present at baseline: multilayer (≥2 layers) vs. single-layer (1 layer). Ten-year clinical outcomes included cardiac death, myocardial infarction (MI), and target lesion revascularisation (TLR). Recurrent TLR during follow-up was assessed by counting first and all subsequent TLR procedures. Results Overall 112 lesions (80 patients) were classified as multilayer and 388 lesions (322 patients) as single-layer. At 10 years, rates of cardiac death (32.0% vs. 29.6%; HR=1.14; 95% CI 0.73–1.78; p = 0.55) and MI (10.1% vs. 5.4%; HR=1.98; 95% CI 0.85–4.63; p = 0.11) were not different in patients with multilayer versus single-layer ISR, rates of TLR were significantly higher in the multilayer group as compared to single-layer ISR (54.1% vs. 40.5%; HR=1.45; 95% CI 1.05–2.02; p = 0.03). Overall, ≥1 repeat PCI was performed in 204 of 500 lesions (40.8%). Compared with single-layer lesions, multilayer lesions were associated with a higher risk of both first TLR (54.1% vs. 39.0%; hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.10–2.13; p = 0.01) and total number of recurrent TLR (HR 1.41, 95% CI 1.03–1.93; p = 0.033). Conclusions In patients undergoing PCI for ISR, lesions with 2 or more stent layers were associated with a higher risk of recurrent revascularisation than single-layer lesions. However, patients in the multilayer group did not have a higher risk of cardiac death or myocardial infarction.
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Lahu et al. (2026) conducted an observational in In-stent restenosis (ISR) (n=402). Multilayer in-stent restenosis (≥2 stent layers) vs. Single-layer in-stent restenosis (1 stent layer) was evaluated on Target lesion revascularisation (TLR) at 10 years (HR 1.45, 95% CI 1.05-2.02, p=0.03). Multilayer in-stent restenosis (≥2 layers) was associated with higher 10-year target lesion revascularization vs single-layer lesions.
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