Digital stent enhancement for coronary stent optimization during PCI: evidence, applications, and future directions

Stent underexpansion remains a major contributor to restenosis and stent thrombosis following percutaneous coronary intervention (PCI), yet intravascular imaging is not used routinely in many settings. Digital stent enhancement (DSE) offers an angiography-based approach to improve visualization of metallic stents through real-time image processing, enabling rapid assessment of stent expansion and deployment abnormalities. In this review, we describe the underlying principles and commercially available DSE systems, summarize diagnostic performance data with emphasis on detection of stent underexpansion, and highlight where DSE may complement IVUS and OCT. Finally, we review emerging innovations, including three-dimensional stent reconstruction, and propose future research priorities to define clinical impact.