A 32-year-old female smoker with systemic lupus erythematosus and antiphospholipid syndrome presented with sudden onset of severe chest pain with persistent angina and ST elevations in the anterior leads. Although she was on warfarin therapy because of recurrent deep venous thrombosis of the calf veins her INR was witin normal range while admitted.. Emergent coronary angiogram showed total occlusion of the left anterior descending (LAD) coronary artery just distal to the first diagonal branch. The right and left circumflex coronary arteries were completely normal. Balon angioplasty was performed leading to TIMI-I flow and revealing a huge organised thrombus. An aspiration catheter was advanced to the LAD to aspirate the thrombus. The aspiration catheter contained only a couple of small fragments of the thrombus. After the thrombectomy, TIMI 3 coronary flow was restored and ST elevation and chest pain of the patient resolved. Glycoprotein IIb/IIIa antagonist was administered during and 48 hours after the procedure along with unfractioned heparin, clopidogrel (150mg) and ASA. A 3.5x12mm bare metal stent was implanted successfully as the control coronary angiogram revealed a partly-diminished but a persistent thrombus in the LAD. The patient was discharged on medical therapy with warfarin (target INR 2.5), clopidogrel (150mg for the first week) and ASA after a long hospital stay without any ischemic event.