Intravascular ultrasound imaging is able to provide direct images of the stent meshwork. However, a paradoxical question remains unanswered: Why is it not possible to correct or prevent implantation defects by ultrasound-guided implantation? We postulate that these discrepancies are due to image artifacts. We performed an in vitro experiment allowing detection, physical characterization, and computerized simulations of the various aspects of these artifacts. The width of the echo of a strut is variable, dependent on its distance from the transducer. The stent strut echo orientation is variable, and depends on the position of the transducer inside the stent. The stent contour image depends on the position of the transducer. In conclusion, knowledge of these stent intravascular ultrasound image artifacts enabled us to discriminate accurately between artifacts and real stent implantation defects, and are indispensable for accurate qualitative and quantitative analyses of stents.