Thrombus aspiration is an effective adjunctive therapy to prevent distal embolization during primary percutaneous coronary intervention (PCI). In some patients, thrombus aspiration results in complete restoration of flow without significant residual stenosis or plaque rupture at the site of occlusion. It is currently unclear if additional angioplasty with balloon or stenting is necessary in these patients. We present 5 cases in which thrombus aspiration was performed without additional angioplasty as treatment for ST-elevation myocardial infarction. During follow up, no patient had an adverse cardiac event. These cases indicate that thrombus aspiration can be performed safely and effectively as definitive treatment in selected patients.