The routine use of intracoronary stents to reduce acute complications and improve the clinical outcome of percutaneous coronary intervention is now well established, with a reduction in the complications of acute closure, myocardial infarction, and emergency surgery, as well as the six month restenosis rate by up to 50%.1-3 However, with the continued incidence of subacute stent thrombosis and the fact that a six month clinical restenosis rate of 10–20% still exists, this suggests that stenting, particularly in “non-Benestent” lesions,4 is less than perfect. Initial experience with coronary stent deployment was characterised by a high thrombosis rate despite aggressive anticoagulant regimens, which increased the risk of early vascular complications.5 ,6 Improvements in clinical outcomes followed from the use of antiplatelet rather than anticoagulant drugs,7 better stent designs, and the evidence from intravascular ultrasound (IVUS) of suboptimal stent expansion with lower pressure deployment. Studies using the latter technique showed that full stent expansion, complete apposition to the vessel wall, and full lesion coverage significantly reduced the incidence of stent thrombosis.8

Most interventionists are confident in deploying intracoronary stents using angiographic guidance alone, given the small incidence of acute stent related problems. However, suboptimal stent deployment after final balloon dilatation has been observed in the majority of cases with IVUS despite a satisfactory angiographic appearance,9 ,10 which has implications for a higher restenosis rate at follow up. For this reason, several recent trials have investigated the use of IVUS to guide stent deployment to see whether its adjunctive use leads to better clinical outcomes at follow up compared to using angiography alone.11-17