The degree of residual plaque burden outside of a stent might be correlated with the degree of intimal hyperplasia. However, the relation between residual plaque burden and angiographic restenosis are still unknown in a large number of patients. Therefore, we evaluated the effect of residual plaque burden after stenting on 6-month angiographic restenosis. Intravascular ultrasound (IVUS)-guided coronary stenting was successfully performed in 723 patients with 785 native coronary lesions. Six-month follow-up angiograms and evaluation of residual plaque burden by IVUS were available in 566 patients (78.3%) with 622 lesions (79.2%). Results were evaluated using conventional methods. The overall angiographic restenosis rate was 23.0% (143 of 622 lesions). There was no significant difference in residual plaque burden between the lesions with and without restenosis (52% vs 51%, respectively, p = 0.148). The angiographic restenosis rate was 20.8% (11 of 53 lesions), 21.6% (51 of 236 lesions), 22.0% (55 of 250 lesions), and 31.3% (26 of 83 lesions) in the lesions with residual plaque burden < 40%, between 40% and 50%, between 50% and 60%, and > 60%, respectively (p = 0.284). Using multivariate logistic regression analysis, the only independent predictor of angiographic restenosis was the IVUS stent area (odds ratio 0.807, 95% confidence intervals 0.69 to 0.95, p = 0.011). Furthermore, even in the lesions with residual plaque burden > 60%, the restenosis rate was 37.3% (23 of 61 lesions) versus 13.6% (3 of 22 lesions ) in IVUS stent areas of < 7 and > or =7 mm(2), respectively (p = 0.031). In conclusion, residual plaque burden outside the stent might not predict angiographic restenosis. IVUS stent area was the only independent predictor of angiographic restenosis.