{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:00:37Z","timestamp":1785128437032,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of the Intracoronary fibrinolysis with distal occlusion (the Marinade technique) in managing refractory no-reflow during ST-segment elevation myocardial infarction in heart transplant recipients remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of a 38-year-old heart transplant recipient who presented with anterior ST-segment elevation myocardial infarction caused by total occlusion of the proximal left anterior descending artery. Despite repeated balloon dilations and thrombus aspiration, severe refractory no-reflow persisted and was complicated by ventricular fibrillation cardiac arrest requiring venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support. Rescue intracoronary fibrinolysis using the Marinade technique\u2014consisting of distal balloon occlusion and localized alteplase delivery with a prolonged dwell time\u2014was repeatedly performed, resulting in partial restoration of coronary flow. Additional selective distal intracoronary alteplase administration via aspiration catheter successfully re-established distal coronary perfusion and thereby allowed completion of percutaneous coronary intervention (PCI). A total intracoronary alteplase dose of 25\u2005mg was administered without major bleeding complications, despite concurrent VA-ECMO support. Although ST-segment resolution was limited, chest pain improved and hemodynamic stabilization was achieved, enabling successful redo heart transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the potential utility of intracoronary fibrinolysis using the Marinade technique as a bailout strategy for refractory no-reflow during PCI, even in high-risk settings such as heart transplant recipients with advanced microvascular dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1835932","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:25:53Z","timestamp":1785126353000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A case of successful treatment of STEMI following intra-coronary thrombolysis and re-transplantation in a heart transplant recipient"],"prefix":"10.3389","volume":"13","author":[{"given":"Seok Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital","place":["Yangsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Yong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital","place":["Yangsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Ku","family":"Chon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital","place":["Yangsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kook Jin","family":"Chun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital","place":["Yangsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1016\/j.healun.2011.04.008","article-title":"Diverse morphologic manifestations of cardiac allograft vasculopathy: a pathologic study of 64 allograft 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