Abstract: AIM: To assess the immediate and mid-term outcomes of combining intracoronary artery rotational atherectomy (RA) and drug-eluting stents in the treatment of extremely heavily calcified lesions. METHODS: Twelve patients were treated with RA followed by drug-eluting stents. Among the 12 patients, routine interventional treatment was unsuccessful in eight patients, among which there was failure of balloon penetrating the calcified lesions in two cases, incomplete expansion of the balloon in three cases and failure of stent passage following successful balloon expansion in three cases. The other four patients were not suitable for routine interventional therapy. The therapeutic efficacy of RA followed by drug-eluting stents and a 6-month follow-up were evaluated. RESULTS: All 12 patients were successfully treated with RA followed by stenting procedure. Of the 12 patients, no-flow was observed in three cases, new dissection after PCI was seen in three cases and severe coronary shock occurred in one patient who received IABP. None of the 12 cases was treated with emergency bypass graft surgery and no deaths occurred. During the 6-month follow-up, in-stent restenosis was found in only one case by angiogram. CONCLUSION: Combination of intracoronary artery RA and drug-eluting stents is an effective procedure with good short- to mid-term efficacy for patients with extremely heavily calcified lesions who have failed routine interventional treatment.