Radiation therapy is an effective and common treatment modality for Hodgkin's lymphoma, with proven long-term high survival rates and freedom from recurrences. However, the development of radiation-induced coronary artery disease, characterized by severe and widespread coronary involvement and by a high mortality secondary to acute ischemic events, is one of the most feared complications of this treatment modality. Furthermore, in such patients the optimal approach to revascularization remains to be determined, owing to some specific technical surgical difficulties and, as reported in the literature, to the limited experience available to date with percutaneous intervention, especially in case of acute ischemic syndromes. We report on a case of acute anterior myocardial infarction with cardiogenic shock in a 29-year-old male who had undergone radiation therapy to the chest for Hodgkin's lymphoma 10 years previously. He was immediately transferred to the catheterization laboratory: intra-aortic balloon counterpulsation was followed by coronary angiography which revealed severe, widespread triple-vessel disease and an acutely suboccluded very large left anterior descending coronary artery providing collaterals to large segments of the right and circumflex coronary territories. Primary angioplasty and stenting of the left anterior descending coronary artery was performed successfully, with a gradual amelioration of the hemodynamic and clinical parameters. Angiographic follow-up at 6 months demonstrated a widely patent stent, with minimal neointimal hyperplasia but no evidence of restenosis. The patient remained asymptomatic. We discuss our therapeutic strategy and review the relevant literature on the subject.