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Objectives We introduced a simple method of transcatheter aspiration of coronary thrombus during emergency PCI in acute myocardial infarction (AMI) patients. Methods AMI patients presenting proximal coronary lesions with intracoronary thrombus were selected. We used the common coronary wire (0. 014") across the lesion after 7F guiding catheter to the ostium of coronary arteries. Aspiration catheter (Export, PercuSurge) was directly advanced over the wire to the lesion and manually aspirated the thrombus with a 20 - ml syringe at the same time. After thrombus disappeared and occluded arteries reopened, stents were directly implanted. Results 12 cases of AMI received the treatment. After aspiration,the thrombus disappeared in 8 cases, and decreased in another 4 cases. The total occluded artery was directly re- opened and the antegrade flow improved markedly after aspiration in 7 out of 8 cases. 9 patients achieved TIMI 3 flow and TMP 3 grade perfusion flow after stenting, and the other 3 cases were TMP 2. No major cardiac events took place during hospitalization. The LVEF was 64.1 ± 9.3% before discharge. Conclusions Transcatheter aspiration of thrombus is a simple and effective method to manage the intracoronary thrombus in AMI patients.