The false illusion of coronary thrombus device-management

Primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) has contributed, in association with optimized antithrombotic therapy, to a dramatic decline in mortality over the last decades (1). Among the numerous mechanisms that may participate to non-optimal myocardial reperfusion during or after the ischemia-reperfusion process, distal embolization of thrombus or debris during primary PCI appears as a cause to be prevented (2,3). Several device-based strategies have been evaluated aiming at improving reperfusion success by reducing distal vessel occlusion and microvascular obstruction (4).