stelevation myocardial infarction in a young adult secondary to giant coronary aneurysm thrombosis an important sequela of kawasaki disease and a management challenge thrombosis of a coronary artery aneurysm caa is a rare trigger for stelevation myocardial infarction stemi and an important cause of stemi in young adults previously affected by kawasaki disease initial management should proceed in line with standard stemimanagement guidelines advocating antiplatelet medication and emergency coronary angiography acute caa thrombosis presents the interventional cardiologist with unique challenges during attempted percutaneous revascularisation in the absence of consensus guidelines experiential reporting can therefore be of great value we report on a 36yearold vietnamese woman presenting with an inferior stemi secondary to two giant thrombosed aneurysms of the right coronary artery coronary wiring and thrombus aspiration temporarily improved coronary flow but recurrent thrombus with distal embolisation resulted in ventricular fibrillation and cardiogenic shock emergency surgical revascularisation subsequently provided a definitive and successful outcome we discuss the challenges of percutaneous coronary intervention in this scenario and review previous reports to give an overview of principles of decisionmaking and management