Late target lesion revascularization is an unusual finding beyond 6-9 months after bare-metal stent implantation. However,late TLR after sirolimus-eluting stent implantation has not been sufficiently evaluated. We evaluated the incidence, clinical presentation, and angiographic in-stent restenosis pattern of late TLR in 804 patients with 1020 native lesions that were patent at 6-month follow-up angiogram after SES implantation. Late TLR was performed in 18 patients with 18 lesions(1.8%) at 24.1짹2.6 months after SES implantation. Clinical presentation of late TLR patients was silent ischemia in 8 patients and recurrent angina in 10 patients, but none had an acute coronary syndrome. Angiographic ISR pattern of late TLR lesions was focal ISR in 12 lesions(67%) and diffuse ISR in 6 lesions(33%). Serial QCA analysis of these lesions showed a minimal lumen diameter of 2.6짹0.5mm immediately after SES implantation, 2.4짹0.4mm at 6-month follow-up and 0.7짹0.6mm at 24-month follow-up (p<0.001). By stepwise multiple logistic regression analysis, the only independent predictor of late TLR was stent length (p<0.001, OR=1.040, 95% CI=1.019-1.061). In conclusions, late TLR was performed in 1.8% of 1020 native lesions that were patent at 6-month follow-up angiogram. Clinical presentations of late TLR was either silent ischemia or recurrent angina, but not Acute coronary syndrome. Two-thirds of late TLR lesions had a focal ISR pattern.