The role of enhanced stent visualization imaging in percutaneous coronary intervention: a systematic review of efficacy and clinical outcomes

Coronary artery disease (CAD) is a major global cause of morbidity and mortality. Percutaneous coronary intervention (PCI) is central to its management, and optimal stent deployment is critical. This systematic review evaluates the efficacy and clinical outcomes associated with enhanced stent visualization (ESV) systems – x-ray-based fluoroscopic tools such as StentBoost and CLEARstent – in PCI. A systematic literature search of PubMed, PubMed Central, and Cochrane Library was conducted according to PRISMA guidelines. Inclusion criteria comprised all study types evaluating ESV use in PCI, excluding case reports and non-English articles. Study quality was assessed using Newcastle-Ottawa tool. Twelve studies involving ESV were included. ESV improved detection of stent expansion and deployment versus standard angiography and showed strong agreement with OCT and IVUS. ESV-guided PCI was associated with reduced rates of major adverse cardiac events (MACE), particularly in long-term follow-up. Radiation exposure was modestly increased but deemed acceptable. ESV systems enhance stent deployment accuracy and clinical outcomes in PCI, offering a cost-effective and accessible alternative to OCT and IVUS. Evidence supports routine integration of ESV in PCI workflows, although further large-scale trials are warranted. PROSPERO identifier is CRD420251020834.