Introduction: The bare-metal stents implantation is associated with high rates of restenosis and poor clinical outcome. The introduction of drug-eluting stents prompted treatment of long coronary lesions with multiple overlapping stents. In this study, we sought to evaluate the clinical and angiographic outcomes of patients receiving multiple overlapping sirolimus-eluting stents (SES) in long diffuse complex coronary lesions with multiple cardiovascular risk factors. Methods: This was a retrospective investigational 6-month follow-up study including 27 patients with previously untreated de novo long coronary lesions (> 50 mm in length), which were treated with multiple overlapping SESs. All patients underwent six-month angiographic follow-up. Results: The rate of diabetes mellitus, hypertension, and smoking were 44.4% (n=12), 59.3% (n=16), and 18.5% (n=5), respectively. Mean body mass index was 25.3 짹 3.4 kg/m짼. The average number of cardiovascular risk factors was 1.7 짹 1.0. All patients demonstrated either B���type of lesion [48.1% (n=13)] or C type of lesion [51.9% (n=14)]. The average lesion length was 56.6 짹 15.1 mm, and the mean total stent length was 64.2 짹 17.0 mm. The average number of stents implanted was 2.6 짹 0.6 (range, 2 to 4). The binary restenosis rate was 18.5% (n=5), and the mean late lumen loss was 0.51 짹 0.60 mm. All 5 patients with restenosis showed type IB pattern (margin). There were no significant differences in baseline and post-procedure reference diameter, minimal lumen diameter (MLD), and lesion length between patients with or without restenosis. The post-stenting MLD revealed no significant difference with or without binary restenosis (2.51 짹 0.45 mm vs. 2.39 짹 0.27 mm, p=0.41). At six-months clinical follow-up, there were 0 death (0.0%), 1 target lesion revascularization (3.7%), 2 target vessel revascularizations (7.4%), and the overall incidence of major cardiac events was 7.4%. Conclusion: The SESs appear relatively safe and effective for de novo coronary lesions requiring multiple overlapping SES implantation over a very long coronary lesion.