Introduction

Several intravascular ultrasound (IVUS) studies have shown that optimal stent deployment was rarely achieved with angiographically-guided angioplasty alone.178-180 The major effect of these studies was the introduction of routine high pressure stenting.179-181 Moreover, stent post-dilatation with larger balloons has become common practice after the documentation of the frequent mismatch between the angiographic and the real vessel diameter,182-184 and the very low incidence of in-stent restenosis observed in the Multicenter Ultrasound Stenting in Coronaries (MUSIC) Study with IVUS-guided stent deployment.185 The choice to post-dilate a stent depends on many factors: operator’s habit, attempt to improve suboptimal angiographic results, IVUSguided stenting. In the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study, after IVUS examination the operators decided to use oversized balloons in 34% of the patients.186 This strategy has been proven to be safe with bare stents, and was not reported to hamper the efficacy of drugeluting stents in the RAVEL trial,18 where it was allowed in order to achieve a less than 20% residual diameter stenosis.