Background To compare the safety and efficacy between TRI and TFI in coronary rotational atherectomy for the treatment of heavily calcified lesions.Methods From January 2008 to September 2012, 107 consecutive patients with heavily calcified lesions who underwent rotational atherectomy in our hospital were enrolled in this retrospective study.Patients were divided according to the vascular approach into two groups: transradial approach (TRI) and transfemoral approach (TFI).We compared the success rates of RA and stenting, rates of complication during perioperations, average time of lying in bed and hospitalization, MACE during hospitalization and after one year follow up.