Introduction : The pathomechanism of the bidirectional pattern of arterial remodeling is not yet completely understood, but it is considered that pre-interventional arterial remodeling play an important part in post-angioplastic restenosis. The aim of this study is to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia after stent implantation in DES era. Method : The study population consisted of 55 patients(61 lesions) with de novo lesion treated with paclitaxel-eluting stent and evaluated by IVUS pre-, post-procedure and at 9 month follow-up. Results : The remodeling index (RI) was 1.19짹0.16 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.81짹0.11 in the negative remodeling (NR) group. The EEM CSA(18.7짹5.4 vs 12.9짹3.7 mm2, p=0.001), plaque plus media CSA(17.0짹4.0 vs 10.3짹3.5 mm2, p=0.001) and plaque burden(85.8짹5.0 vs 81.8짹7.3 %, p=0.048) at pre-intervention and NIH CSA(2.7짹2.3 vs 0.8짹1.3 mm2, p=0.001) at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group compared to NR group. A significant positive correlation was found between pre-interventional RI and pre-interventional plaque plus media CSA(r=0.594, p=0.001) and follow-up NIH CSA (r=0.406, p=0.001). However, minimal lumen CSA(6.2짹2.4 vs 6.2짹2.1 mm2) at follow-up and the incidence of ISR(2/33 vs 3/28) were not different between both groups. Conclusions : In DES era, pre-interventional arterial remodeling influenced the development of NIH and pre-interventional RI correlated with the extent of pre-interventional plaque area and follow-up in-stent NIH.