Acute myocardial infarction (AMI) can be caused by a ruptured plaque with sudden thrombosis occlusion or an embolization formation. Previous investigations have described the use of thrombolytic therapy, balloon angioplasty plus stenting, and various mechanical thrombectomy devices to treat patients with AMI with intracoronary thrombus, but all of these methods have certain limitations. The authors report 2 cases of AMI, 1 caused by ruptured plaque and the other caused by embolization, with large thrombus formation and total occlusion of the infarct-related artery. Manual thrombosuction with the Export catheter proved effective and safe for treating these 2 patients and achieved final thrombolysis in myocardial infarction (TIMI) III flow with good myocardial brushing.