We conducted a retrospective comparison of the long-term clinical and angiographic outcomes of 281 consecutive nonrandomized severely calcified lesions in 221 patients treated with a sirolimus-eluting stent (SES; CYPHER Bx VELOCITY) or a paclitaxel-eluting stent (PES; TAXUS Express) placed after rotablation between August 2004 and February 2009. The clinical safety endpoint, comprising the incidence of cardiac death, nonfatal recurrent myocardial infarction, and definite stent thrombosis, in 164 patients after exclusive SES placement (4.9 % with a mean clinical follow-up period of 1396 ± 763 days) was not significantly different from that after exclusive PES placement in 51 patients (2.0 %, 1011 ± 605 days; p = 0.364 and p < 0.001, respectively). The cumulative clinical safety endpoint-free ratio after exclusive SES placement was not significantly different from that after PES placement (p = 0.61, by log-rank test). The angiographic efficacy endpoint (binary restenosis: diameter stenosis >50 % at follow-up angiography) in the 169 lesions placed using SES (20.1 % with a mean angiographic follow-up period of 669 ± 605 days) was not significantly different from that in the 40 lesions using PES (17.5 %; 498 ± 320 days) (p = 0.707). In univariate analysis, SES use did not relate to the efficacy endpoint (p = 0.707). Thus, our small single-center study showed that the long-term clinical and angiographic outcomes after SES placements for severely calcified lesions after rotablation were not significantly different from those after PES placement.