Background PCI to small vessel disease has been a challenge due to higher rate of recurrence. Further, DM is also known to be an independent predictor of restenosis. This study was to evaluate the efficacy of paclitaxel-eluting stents (Taxus) in diabetic patients with very small lesion. Methods PES were selectively implanted in 64 pts with very small, denovo coronary artery lesions (less than 2.5mm). The angiographic and clinical outcomes of DM group (n=30) were compared with those of non-DM group (n=34) at 6 months. Results The baseline characteristics were well matched between two groups. The procedural success rate were high in both groups (93.5% vs. 97.5%, P=0.177). At 6-month follow-up, the angiographic and clinical outcomes were similar between two groups but showed higher rate of restenosis(20% vs 30.8%, P=0.453). Characteristically, the overall incidence of binary restenosis was 24%, but there was only one TLR, minimizing oculo-stenotic reflex. Only 1 cardiac death in DM group and 1 TVR in non-DM group occurred up to 6-months follow-up, suggesting excellent clinical outcomes in this population. The survival and freedom from MACEs was similar between two groups(96.67% vs. 97.06%, P=1.000). Conclusion DES implantation using 2.25 PES in diabetic pts with very small vessel lesion was safe and showed excellent clinical outcomes although the incidence of binary restenosis was relatively higher.