Background: Platelet activation and aggregation, with resultant arterial thrombus formation, are pivotal in the pathophysiology of acute coronary syndromes. Blockade of the platelet glycoprotein IIb/IIIa receptor with abciximab has been shown to diminish ischemic complications among patients undergoing high-risk coronary angioplasty. We tested whether abciximab-coated stent prevents neointimal formation effectively. Methods and results: A total of 85 consecutive patients underwent stent implantation for the treatment of coronary de novo lesions. We performed a prospective, randomized trial to compare abciximab-coated stents, which were implanted for 43 patients, with control stents, which were implanted for 42 patients. Follow-up coronary angiogram and intravascular ultrasound (IVUS) were performed in all enrolled patients. All stents were successfully deployed and patients were discharged home without clinical events. At follow-up coronary angiogram, the restenosis rate and late loss were 14% and 0.33짹0.28 mm in abciximab-coated stent group and 28.6% and 0.64짹0.32 mm in control stent group (p=0.099, 0.014, respectively). At follow-up IVUS, intrastent lumen area and intrastent neointimal hyperplasia (NIH) area were 5.7짹1.6 mm2, 2.0짹1.6 mm2 in abciximab-coated stent group and 4.2짹0.8 mm2, 3.4짹1.7 mm2 in control stent group (p=0.001, 0.001, respectively). A positive remodeling at pre-intervention was observed more frequently in in-stent restenosis (ISR) group than that in no ISR group (44.4% vs. 10.4%, p=0.002). Conclusion: Abciximab-coated stent is feasible and produces a significant inhibition of neointimal hyperplasia and shows potential therapeutic benefit in the prevention of stent restenosis.