Background Neointimal hyperplasia and resulting restenosis limit the long-term success of coronary stenting. Heavy metal ions induce inflammatory and allergic reaction, and lead to in-stent restenosis. However, carbon ion-implanted surface might prevent heavy metal ions to diffuse into surrounding tissue. Methods We conducted randomized, controlled study to compare a carbon ion-implanted stent with a standard unimplanted stent for coronary revascularization. At our center, 140 lesions in 140 patients with coronary lesions underwent implantation of carbon-implanted surface stents (Arthos^inert stent group, n=70) or control stents (Arthos stent group, n=70). The primary end point was the in-stent restenosis (luminal narrowing of ��� 50%) and the secondary end-point was the value of hs-CRP at 48 hours and 6 months after coronary stenting. Clinical follow-up was performed at one month and six months, and angiographic follow-up at six months. Results Angiographic data at 6 months were available for 97 of 140 lesions (69.3%). Baseline characteristics in both group were similar, and the success rate of the procedure was 100%. The rate of in-stent restenosis was lower in Arthos^inert stent group (15.9%, 10/63) than in Arthos stent group (20.6%, 7/34), but there was no significant differences between both groups (P=0.56). The value of hs-CRP at 48 hours was lower in Arthos^inert stent group (15.4짹13.5 mg/dL) than in Arthos stent group (28.7짹40.7 mg/dL) with significant differences (P=0.002). But, the value of hs-CRP at 6 months was higher in Arthos^inert stent group (2.1짹6.3 mg/dL) than in Arthos stent group (1.7짹2.0 mg/dL) without significant differences (P=0.76). There were no major cardiac events, including episodes of acute and subacute thrombosis in both groups. Conclusions As compared with a standard coronary stent, a carbon ion-implanted stent shows no considerable difference for the prevention of in-stent restenosis within the range of this study. Despite all the limitations of this study, a positive effect of a carbon ion-implanted stent in reducing inflammatory reaction after coronary revascularization seems likely.