Aim To assess the efficiency of rotational atherectomy （RA） with drug-eluting stents （DES） for heavily calcified lesions. Methods By retrospective analysis of 31 cases of severe calcified coronary atherectomy with interventional treatment of patients, 13 patients were carried out under the guidance of intravascular ultrasound （IVUS）, and we analyzed the clinical characteristics, immediate success rate of percutaneous coronary intervention （PCI）, and cardiac events of hospitalization and long-term follow-up results. Results The mean age of 31 patients was 71.81±10.70 years,and 22 patients were male, 9 patients were female. Their coronary artery were confirmed as severely calcified coronary by angiography, including single-vessel disease in 2 cases （6.5%）, double vessel disease in 7 cases （22.6%）, three lesions in 15 cases （48.4%）, left main （LM）＋three lesions in 1 case （3.2%）, LM disease in 6 cases （19.4%）. Rotational atherectomy target vessel in LM-left anterior descending artery （LAD） was 2 cases （6.5%）, LAD was 22 cases （70.9%）, left circumflex artery （LCX） was 2 cases （6.5%）, LAD＋LCX was 1 case （3.2%）, right coronary artery （RCA） was 4 cases （12.9%）. 1 case （3.2%） needed intra-aortic balloon pump （IABP） intraoperation, 6 cases （19.4%） were presented with coronary dissection and 2 cases （6.5%） were with slow flow, but all of them were successfully implemented with rotational atherectomy and stent implantation. Serum troponin T, serum creatine kinase-MB, and serum creatinine had no significant difference. 13 cases were carried out by IVUS, and the minimum lumen diameter, the smallest diameter stenosis rate, the effective area of ？？the lumen had significantly statistical difference pre- and post-operative, respectively（2.0±0.3 mm vs 3.6±0.8 mm, 74.5%±6.8% vs 20.3%±12.5%, 4.0±1.4 mm² vs 10.7±5.5 mm², P＝0.000）. With an average follow-up 10.4±6.4 months, no angina, acute myocardial infarction, sudden cardiac death, target vessel revascularization occurred. Conclusions The combination of rotational atherectomy with stents may selectively ablate calcific plaque and may increase the success rate of the PCI.