ABSTRACT
INTRODUCTION The advent of coronary stents into clinical practice resulted in lower rates of restenosis and superior long-term outcomes compared to balloon angioplasty.1,2 However, the initial experience with coronary stenting in the early 1990s was associated with elevated incidence of acute and subacute stent thrombosis, vigorous antiplatelet/anticoagulant therapeutic regimen, and relatively high rates of restenosis and vessel revascularization; therefore, it became limited to a narrow subset of patients in the early years.3,4 It was Colombo’s pioneering work with intravascular ultrasound (IVUS) guidance for stent deployment with high pressure that deeply impacted the way to perform contemporary percutaneous coronary intervention (PCI), allowing stents to evolve into the most widespread modality for treatment of coronary artery disease (CAD).5
Although IVUS has never been consistently proved to optimize routine stent implantation, it continued to play a pivotal role for understanding CAD as well as assessing the mechanisms of PCI failure.6 Specifically, serial IVUS examinations have been demonstrated that “suboptimal” stent implantation is one of the main causes associated with stent thrombosis and restenosis.7,8
In the current era, drug-eluting stents (DES) have shown an overall marked efficacy and superiority compared to bare-metal stents (BMS) in reducing neointimal hyperplasia and restenosis, and therefore, the need for repeat revascularization.9,10 Importantly, several IVUS studies still demonstrate that “optimal” stent implantation with adequate stent expansion remains one of the most important factor impacting acute and long-term success after DES.11,12
