This study demonstrates the application of a combined imaging balloon catheter for delivery and ultrasound-guided expansion of Palmaz-Schatz coronary stents. IVUS offered a comprehensive insight into the stented coronary segments, revealing a substantial overestimation of stent dimensions by angiography. IVUS guidance led to a significant improvement of stent expansion. This additional lumen gain, which was not discernible by angiography in most patients, might result in a reduction of subacute stent thromboses as well as restenoses.