The aim of this study is to demonstrate initial results and long-term outcomes of patients after cutting balloon angioplasty (CBA), balloon angioplasty (BA), or stent implantation for small vessel diseases. We studied a total of 327 small coronary disease cases of less than 2.5 mm, treated either by CBA (87 lesions), BA (130 lesions), and stenting (110 lesions). Angiographic restenosis was encountered in 31% of the CBA cases, 46.5% of the BA, and 43.9% of the stent (p=0.048). The CBA revealed an event-free advantage at 9 months (p=0.036). The CBA procedure provided superior angiographic and clinical outcomes to the stenting and BA in small coronary diseases.