Successful intracoronary thrombolysis for extensive right coronary artery luminal thrombotic occlusion

A 46-year-old man who had failed primary angioplasty to the dominant right coronary artery due to high thrombus burden 2 years previously, presented with non-ST-elevation myocardial infarction following discontinuing antiplatelet therapy for 2 months. Angiography showed occluded right coronary artery with extensive thrombus burden. There was no significant left coronary artery disease. Due to failure of thromboaspiration and angiojet from the previous attempt 2 years previously, intracoronary thrombolysis with streptokinase was administered via thromboaspiration catheter. Following intracoronary thrombolysis, aspiration catheter was able to retrieve the majority of thrombi and achieved thrombolysis in myocardial infarction 3 flow at the end of the procedure with resolution of transient ST elevation. This case demonstrated that the use of adjunctive intracoronary thrombolysis and manual aspiration in a patient presenting with myocardial infarction with heavy thrombus burden might be useful in selected cases. <Learning objective: The use of adjunctive intracoronary thrombolysis and manual aspiration in a patient presenting with myocardial infarction with heavy thrombus burden might be useful in selected cases.>.