The treatment of coronary artery lesions by percutaneous coronary intervention (PCI) has two major problems, first complications arising from the implantation process and early reocclusion, second the long-term patency of the procedure especially when comparing outcomes to the long-term results of coronary bypass surgery. The introduction of drug-eluting stents (DES) and advances in stent design towards thinner struts for the metallic framework of the stent resulted in improvement in both acute and long-term results [1] . There are various drug components used for DES, but there seem no material differences in the efficiency of those DES presently available. The influence of strut thickness on both the early endothelialization relevant to avoid long-term dual antiplatelet therapy (DAPT), and late neoatherosclerosis to prevent late stent occlusions have become the focus of technological developments [2] . The potential benefit of thinner struts was highlighted for bare metal stents in the ISAR-STEREO trial [3] . Already at that time, a further analysis showed that the benefit of advantageous stent designs might be best highlighted in more complex lesions [4] . Now in the era of DES, strut thickness became again of interest to find further improvements in delivery of the stent and of long-term outcome. Several studies in selected lesions and in real-world settings compared so-called ultrathin strut DES (UTS) to the thin-strut DES (TS), the comparative gold standard among the latter being the Xience everolimus-eluting stent (Abbott Vascular, Temecula, CA, USA). For target lesion related endpoints, but not in “hard” clinical endpoints such as cardiovascular and all-cause mortality, there seemed to be an advantage of some UTS [56] . Among these trials and registries, the Osirio (Biotronik, Bulach, Switzerland) is the best investigated UTS.