To clarify the incidence of stenotic lesions according to the coronary arterial diameter in the acute phase. we investigated 190 patients with coronary arterial lesions who underwent an initial coronary angiogram (CAG) less than 100 days after the onset of Kawasaki disease. The largest diameters of the major branches were measured in the initial CAGs. The diameter of the large group was > or = 8.0 mm, that of the medium group was > or = 6.0 mm but < 8.0 mm, and that of the small group was > or = 4.0 mm but < 6.0 mm. There were 121 patients in the large group, 85 in the medium group, 77 in the small group. We investigated the stenotic lesions in the follow-up CAGs and evaluated the incidence of stenotic lesions in each group by the Kaplan-Meier method. The mean interval from the initial CAGs to the latest CAG was 97 months. The incidence of stenosis at 5, 10, and 15 years in the large group was 44, 62, and 74%, respectively. In the medium group the corresponding values were 6, 20, 58%, respectively. None of the patients in the small group developed stenotic lesions. Dilatation of more than 6.0 mm produces a high probability of irreversible change in the coronary arterial wall, leading to subsequent stenotic lesions.