Background: Large thrombus burdens in ectatic coronary arteries that remain after aspiration thrombectomy can\nnegatively impact outcomes following percutaneous coronary interventions in patients with acute myocardial\ninfarction.\nCase presentation: A 53-year-old man presented with ST-segment elevation myocardial infarction (STEMI).\nCoronary angiography revealed an ectatic right coronary artery (RCA) that was completely occluded in the mid\nportion by a large amount of thrombus. Catheter-directed intracoronary thrombolysis with alteplase led to recovery\nof coronary blood flow, which multiple attempts of aspiration thrombectomy had failed to achieve. Coronary\nangiography 9 days later showed good blood flow and insignificant stenosis remaining in the RCA; this had\ncompletely resolved in 6 months� follow-up coronary angiography.\nConclusion: Catheter-directed intracoronary thrombolysis can be performed effectively and safely when repeat\naspiration thrombectomy fails to produce satisfactory coronary reperfusion in STEMI patients with large thrombus\nburdens in ectatic coronary arteries.
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