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Organized intracoronary thrombus is associated with adverse outcomes due to distal embolization and no-reflow phenomenon during PCI, particularly in large or ectatic coronary arteries. Intracoronary thrombolysis is an underused but effective and safe strategy. We describe the case of a 56-year-old man admitted due to a subacute myocardial infarction with massive thrombus burden in a right ectatic coronary artery to present the usefulness of a sequential approach with intracoronary thrombolysis, thrombus aspiration and a novel mesh-covered stent implantation as a reasonable and effective strategy to avoid a no-reflow phenomenon during PCI, achieving an immediate successful angiographic result, and a positive long-term clinical outcome.