ST-elevation myocardial infarction (STEMI) is a serious and life-threatening event often caused by atherosclerotic plaque injury and thrombus formation in the coronary lumen. The standard treatment for STEMI is reperfusion with angioplasty; however, in some cases, there are concerns about successful angioplasty and stenting due to the large volume of thrombus, such as thrombotic occlusion of an ectatic coronary artery. In these cases, treatment strategies may be different. 1,2 We report a case of successful coronary reperfusion through a catheter-directed intracoronary (IC) thrombolysis in acute STEMI caused by thrombotic occlusion of an ectatic coronary artery. 2 | CASE REPORT A 38-year-old female patient was presented with persistent retrosternal chest pain, having started 4 hours prior to admission. The patient had no coronary risk factor. The pain increased with exertion and did not radiate to any area. Blood pressure of 125/75 mm Hg and heart rate of 78 beats/minute were recorded at the time of admission.