Example of IVUS-guided stent optimization following the OPTIMAL-optimization criteria.

Before optimization, IVUS showed stent underexpansion at the ostium of the LAD (stent area 5.42 mm² [target > 6 mm²]), at the ostium of the LCx (stent area 4.90 mm² [target > 5 mm²]) and in the proximal LCx (minimum stent area 4.74 mm² [target > 5 mm²] accounting for 69.8% of the distal reference area [target > 90%]) (Red boxes in the upper half of the figure). Further postdilation on the LAD and LCx was performed, completing with FKI and final POT. After optimization, IVUS confirmed achievement of stent expansion targets in all segments, including those who appeared initially suboptimally expanded (Green boxes in lowed half of the figure). (LAD: left anterior descending; LCx: left circumflex; LMCA: left main coronary artery; MSA: minimal stent area; PB: plaque burden; POC: polygon of convergence; SA: stent area).