Microvascular obstruction (MVO) is one of the most frequent complications encountered dur- ing primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. The embolization of thrombotic material seems to be the leading cause of MVO, and many clinical trials have demonstrated that thrombus aspiration (TA) may be a useful means of preventing this phenomenon. Continuous advancements in technology have contributed to the development of various devices for thrombus aspiration. However, a review of the literature indicates that there is disagreement regarding the role of TA in the prevention and treatment of MVO. TA is increasingly used in the treatment of acute stroke in patients who are admitted to the hospital within eight hours from the onset of symptoms. This review pre- sents the current knowledge regarding the role of TA in the prevention of MVO.