Recurrent obstruction and thrombolysis of the right coronary artery.

A patient presented twice with the hyperacute phase of inferior wall myocardial infarction. Emergency coronary angiography was undertaken on each occasion and the occluded right coronary artery reopened by intracoronary thrombolysis using urokinase. The patient subsequently underwent successful percutaneous transluminal coronary angioplasty to dilate the underlying subtotal obstructive lesion in the proximal right coronary artery. The sequence of events in this patient demonstrates that (1) acute coronary thrombolysis can preserve ventricular myocardium, (2) recurrent thrombolysis can be performed successfully in the same artery in the same patient, and (3) coronary angioplasty may be an effective method of dilating the underlying coronary narrowing after coronary thrombolysis.