This compelling case series highlights the critical role of IVUS and OCT in navigating complex coronary interventions. Each case illustrates how intravascular imaging supports precise lesion characterization, guides appropriate device selection, and ensures optimal stent deployment. From treating left main disease with proximal LAD remodeling to managing severe calcification with metal-less angioplasty, imaging proves to be central to strategy and success. In high thrombus burden and ectatic segments, IVUS/OCT enabled targeted intervention while minimizing risk. Additionally, imaging helped detect complications like longitudinal stent deformation and stent failure.

These cases underscore how intravascular imaging enhances procedural safety, decision-making, and long-term outcomes in advanced PCI scenarios.