Significant advances have been made with new generation stents to further improve the results of percutaneous coronary intervention (PCI) and outcomes for patients. Drug-eluting stents introduced in the early 2000s, thinner strut stent platforms, and bioabsorbable polymers and stents are among these developments.1 Despite these advances, there remain some areas where optimal stenting continues to be a challenge, in some cases affecting patient outcome. Stent sizing is often a challenge in large, ectatic or aneurysmal vessels; tapered vessels; and in vasoconstricted arteries such as in ST-segment elevation myocardial infarction (STEMI) or chronic total occlusions (CTOs). The rate of major adverse cardiac events (MACE) and particularly stent thrombosis after primary PCI in patients with STEMI continues to be higher than in PCI for stable patients.2 Restenosis and MACE rates after PCI of saphenous vein grafts (SVGs) or bifurcations are also higher than in simple stenting of a native artery.3,4,5 The incidence of no-reflow and reduced microvascular perfusion in vessels with a large thrombus burden is also greater, one cause of which is distal embolisation.6 Atypical coronary arteries and presentations such as these continue to pose a challenge today in PCI with current balloon-expandable stents. This article examines whether self-expandable stents could address some of these issues and provide an alternative solution in the treatment of atypical coronary anatomy.