Rotational atherectomy (RA) is a proven technique to modify a heavily calcified coronary lesion if balloon angioplasty failed. RA is frequently avoided in ST-elevation myocardial infarction (STEMI) as it may increase the risk of slow or no-reflow. It is also considered to be relatively contraindicated in lesions with a visible thrombus, by its manufacturer. Regardless, RA may be a life-saving procedure in cases where no other percutaneous coronary intervention (PCI) technique is available to modify the lesion adequately. This case reports successful use of RA to facilitate dilation and stent delivery of a previously non-dilatable lesion in a patient with sub-acute anterior STEMI complicated by cardiogenic shock.