From September 1991 until November 1993 we randomized 308 patients with 325 long coronary lesions (> 10 mm) to Excimer Laser Coronary Angioplasty (ELCA, n = 151) or Balloon Angioplasty (BA, n = 157). We report on the longterm clinical and angiographic outcome of this trial. Procedural success (PS) was defined as < 50% residual stenosis at the end of the procedure. Clinical endpoints were: death (D), myocardial infarction (MI), coronary bypass surgery (CABG) or repeat angioplasty (re-PTCA) of the randomized segment within 6 months follow-up. Angiographic endpoint was the net gain (NG) in minimal lumen diameter at six months follow-up relative to the preprocedural baseline determined by a computer-assisted automated edge detection algorithm (CAAS II). Functional status (FS) at six months was graded according to the Canadian Cardiovascular Society classification. Results Baseline patient characteristics were similar in both groups. ELCA was followed bij BA in 98% of the treated lesions. n PS (%) D/MI/CAB/re-PTCA NG ± SD FS (0-IV) ELCA 151 80 0/7/16/32 0.4 ± 0.7 91/17/31/11/1 BA 157 79 0/9/17/29 0.5 ± 0.7 94/17/27/17/2 None of the comparisons were significantly different. Conclusion Excimer Laser Angioplasty compared to Balloon Angioplasty in long coronary lesions yields similar results with respect to longterm clinical and angiographic outcome.