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In the bare-metal stent era, numerous studies have shown a strong association between small final stent dimensions at post-deployment and in-stent restenosis at follow-up, 1-3 which led to the so-called bigger-is-better strategy for bare-metal stent optimization. After the introduction of drug-eluting stents (DES), several studies have consistently demonstrated that DES have considerably lower optimal thresholds of final stent dimensions to predict subsequent restenosis because of significant suppression of neointimal proliferation within the stent. 4 Combined with the fact that some early DES trials demonstrated a relatively high incidence of restenosis at the stent edge segment, the stenting procedure in the DES era has changed from the aggressive to the adequate strategy. In clinical settings, however, final stent expansion often fails to meet expected stent dimensions after DES implantation. 5 Furthermore, there is compelling clinical evidence that significant stent undersizing of DES often ends up with suboptimal results, particularly stent underexpansion, which can lead to adverse clinical events, such as restenosis and stent thrombosis. [6][7][8] Therefore, selection of proper device size relative to the target vessel may be considered as important as postdeployment optimization strategy. Recently, the importance of accurate device sizing has also gained further attention due to the introduction of bioresorbable scaffold technology into the clinical arena because polymer-based devices cannot be overly dilated after implantation.At the other end of this spectrum, however, potential effects of oversized stent implantation on arterial wall injury and vascular response have not been systematically evaluated. Thus, the aim of this study was to investigate the impact of stent oversizing on acute and long-term outcomes after DES implantation in de novo coronary lesions.Background-Although significant undersizing often results in incomplete stent apposition or underexpansion, the possible impact of oversized stent implantation on arterial wall injury has not been systematically investigated with drug-eluting stents. The aim of this study was to investigate the impact of stent oversizing on acute and long-term outcomes after drugeluting stents implantation in de novo coronary lesions. Methods and Results-Serial (baseline and 6-12 months) coronary angiography and intravascular ultrasound were performed in 2931 lesions treated with drug-eluting stents (355 sirolimus, 846 paclitaxel, 1387 zotarolimus, and 343 everolimus). The percentage of stent oversizing to angiographic reference vessel diameter (RVD) was calculated as (nominal stent diameter-RVD)/RVD×100 (%). Clinical outcomes, including target lesion revascularization and stent thrombosis, were followed for 1 year. Overall, smaller preintervention RVD was associated with higher percentage of stent oversizing (P<0.001). The significant oversizing group underwent less post-dilatation (P=0.002) but achieved greater stent expansion (P<0.001) and less incomplete stent...

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