Ivan J Nuñez-Gil

Background Managing high thrombotic burden in the context of myocardial infarction remains a challenging scenario. Case summary A 51-year-old male was admitted for a subacute inferior myocardial infarction with persistent chest pain. Emergent coronary angiography showed an ostial–proximal thrombotic occlusion of a large ectatic right coronary artery. Several balloon inflations were performed that were not able to improve distal TIMI flow beyond II. With the intent of vaporizing the remaining thrombus, Excimer Laser Coronary Angioplasty was performed with a favourable outcome. Discussion The present case constitutes an opportunity to revisit percutaneous and non-percutaneous strategies to tackle persistent coronary thrombus showing a contemporary approach to niche technologies such as laser angioplasty.