We examined 49 coronary stents in 33 patients after angiographically guided optimization of the deployment by intracoronary ultrasound, and compared the findings of a conventional 2-dimensional analysis approach with the results obtained from an automatic lumen recognition provided by a 3-dimensional reconstruction system. The automatic lumen analysis demonstrated that only 15 stents (31%) fulfilled defined ultrasound criteria of adequate stent deployment, and that 5 of these cases were missed by the conventional approach, which systematically overestimated the dimensions of the minimal stent lumen.