Primary percutaneous coronary intervention, (pPCI), of native coronaries and saphenous vein grafts (SVGs), is
the recommended reperfusion strategy for STEMI, and an early invasive approach is recommended for high risk patients
with UA/NSTEMI. Although PCI effectively restores flow in the infarct related artery/culprit vessel in both situations,
myocardial perfusion often remains suboptimal due to microvascular obstruction, partly attributed to distal embolization
of thrombus. Hence, thrombectomy (manual or mechanical), prior to stenting may further reduce hard clinical end points
in patients with ACS. This article discusses accumulated evidence regarding the safety and effectiveness of thrombectomy
in culprit native coronaries and SVGs in such patients, as well as possible strategies for maximizing its benefits relative to
the size of the thrombotic burden.