Primary percutaneous coronary intervention is the standard treatment in patients with ST-segment elevation myocardial infarction achieving a TIMI 3 flow in more than 90% of patients. However, despite a brisk epicardial coronary flow in the infarct-related artery, frequently post-ischemic microvascular damage limits the efficacy of primary PCI. Recent studies suggest that thrombectomy during primary PCI, in patients with intracoronary angiographically visible thrombus, represents a useful adjunct to pharmacotherapy able to prevent distal embolization.