Thrombus remains the bane of interventional cardiology. The use of thrombus extraction devices and distal protection devices has been controversial. Pharmacological modulation using intracoronary (IC) thrombolytic therapy during percutaneous coronary intervention (PCI) is also not an established choice although intravenous thrombolytic therapy is widely accepted and applied treatment of choice for acute ST-elevation myocardial infarction (STEMI). This case report shows successful management of a patient of STEMI using a combination of IC thrombolytic therapy, thrombectomy device, and PCI.