Iridium oxide has been successfully used on pacemaker electrodes for a number of years. Its’ potential for use on coronary stents has now been explored, with initial clinical data showing favorable performance compared to traditional stainless steel devices. This paper reviews some of the unique surface characteristics of iridium oxide and introduces the theory on how this surface leads to improved vascular compatibility. A range of bench and pre-clinical data is presented to complement the theory and the clinical observations.