A 48-year-old woman was admitted for an acute infero-lateral myocardial infarction (AMI). The coronary angiography showed an occluded aberrant left circumflex artery taking off from the right sinus of Valsalva of the aortic root. This rare coronary anomaly represents a challenge for interventional cardiologists, especially in the setting of AMI, since it may be difficult to identify an aberrant occluded vessel, to predict its origin and course and finally to choose the material which offers an adequate support during the revascularization procedure. In this particular case, the percutaneous treatment of initially occluded aberrant circumflex artery was performed successfully.