Objective To assess the safety and efficiency of long-term outcome after rotational atherectomy (RA) followed by long drug-eluting stent (DES) implantation in severe calcified coronary lesions. Methods Patients with severe calcified coronary lesions treated with RA followed by long DES in our department between January and December 2010 were enrolled. Their procedural success rate, preoperative complications, and postoperative major adverse cardiovascular events (MACE, including cardiac death, myocardial infarction and target lesion revascularization) were recorded and analyzed. All patients were available for our long-term follow-up. Results Twenty-one patients with complex calcified coronary lesions were treated with RA followed by long DES, with age of (65.2±6.9)years. There were 16 patients (76.2%) having hypertension, 7 (33.3%) having diabetes mellitus and 1 (4.8%) having chronic renal failure. There were totally 35 stents implantated in 20 calcified coronary lesions (1.75 per lesion). One patient did not finish the operation due to the drill head could not go through the lesion. The overall procedure success rate was 95.2% (20/21). The shortest length of the implanted stent was 28 mm, and the average length of total stent /lesions was 48 mm (ranging from 29 to 66 mm). The preoperative complications included 1 case of coronary spasm, and 1 case of chest pain with decreased heart rate, and the postoperative complication only had 1 case of gastrointestinal bleeding. There was no patient having the incidence of in-hospital MACE. During a median follow-up period of 26 months (ranging 20 to 31 months), only 1 patient (4.8%) had acute myocardial infarction at 1 month after operation, and the other were in stable sound condition. Conclusion RA followed by long DES implantation appears to be feasible and effective in treatment of complex calcified coronary lesions, with a high rate of procedural success and low incidence of MACE in a long-term period.