A 67-year-old man was admitted to our institution with sudden and persistent chest pain for 3 days. Coronary angiography showed massive thrombotic occlusion of the right coronary artery. The patient received intracoronary thrombolysis with alteplase (recombinant tissue-type plasminogen activator, rt-PA). On repeated angiography, there was marked resolution of intracoronary thrombus. After percutaneous coronary intervention with stent implantation, the final result was complete revascularization of the right coronary artery (TIMI grade 3 distal flow). This case demonstrates that intracoronary rt-PA can result in local thrombus reduction in patients undergoing PCI, especially with a large thrombus burden.
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