The most seen pathophysiological mechanism of acute coronary syndrome is intracoronary thrombus after plaque rupture. ST elevation myocardial infarction is caused by occlusion of coronary arteries. The treatment is based on fibrinolytic treatment or coronary intervention. If there is massive thrombus burden in coronary artery we can use manuel thrombus aspiration. In our case, we treated patient, who referred to hospital with ST elevation myocardial infarction, by manual thrombus aspiration without using stent.