The abundant thrombi present in infarct-related arteries may impair the angiographic result of primary angioplasty in acute myocardial infarction. We describe the utilization of the thrombus-removal device X-Sizer before coronary stenting in 4 patients with acute myocardial infarction treated with primary angioplasty. The procedure was successful in all the cases and the patients were discharged without complications.