A 27-year-old male had a history of Kawasaki disease (KD) at 3 years of age, and had been continued on low dose aspirin due to a right coronary artery (RCA) aneurysm. At 8 years of age, he was referred for angiographic evaluation of coronary arteries due to intermittent chest tightness. A dipyridamole stress thallium 201 single-photon emission computed tomography (SPECT) showed a reversible perfusion defect in the inferior wall of the left ventricle (Figure 1A). Coronary angiography showed multiple aneurysms and severe stenosis at the proximal segment of RCA (Figure 2A and B, Supplementary Video 1). Initial balloon angioplasty was unsuccessful (Figure 2C). Intravenous ultrasound showed a severe luminal narrowing, aneurysms with calcifications, and intimal proliferations (Figure 3). Percutaneous transluminal coronary rotational ablation (PTCRA) was done with a 2.0 mm-sized burr, resulting in 30% residual narrowing in the target lesion (Figure 2D). Follow up SPECT at 6 months after PTCRA showed no perfusion defect (Figure 1B). At 20 years of age, coronary angiography demonstrated a restenosis of the target lesion (Figure 4A, Supplementary Video 2). Fractional flow reserve measurement was 0.66 (Figure 5), then a repeated PTCRA was done with a significant improvement (Figure 4B, Supplementary Videos 3 and 4). At present, the patient is 27 years old and doing well without any cardiovascular symptoms.