Managementofthrombusincoronarylesionsremainsachallengethatisfrequentlyencounteredduringprimarypercutaneouscoronaryintervention(PCI)forST-elevationmyocardialinfarction(STEMI)andisusuallyassociatedwithpoorclinicaloutcomes.Atthesametime,theoptimummanagementofsuchlesionsremainsadilemma.Multiplethrombusremovalprocedureshaveemergedwiththeshort-termaimofimprovingmyocardialperfusionandalonger-termaimofdecreasingtheincidenceofbothmajoradversecardiacevents(MACE)andall-causemortality.Inthisreview,wewillhighlightthemainproceduresutilizedforthrombusremovalduringprimaryPCIforSTEMI,withparticularemphasisonaspirationthrombectomy.Wewillalsoapproachpossibletheoriesthatmightexplaintheapparentlackofclinicalbenefitrecentlyshownwithsuchprocedures.
