A dilemma must be faced when deciding whether or not to use thrombolytic therapy in patients with acute myocardial infarction and circulating antiphospholipid antibody. This report is about a patient whose infarct-related coronary artery was successfully revascularized by recombinant tissue plasminogen activator without any major bleeding complications. The nature of the infarct-related artery was described by the use of intravascular ultrasonography.