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We consider herewith acute ST-elevation myocardial infarction cases having high grade thrombus who underwent direct stenting or direct like stenting of the culprit vessel in those a drug-eluting stent was not crossable directly or distal landing zone was not visible directly after successful guidewire navigation in distal true lumen. All the 4 patients had presented with acute STEMI and high-grade thrombus on angiography. All of them were treated with percutaneous coronary intervention incorporating either direct stenting or direct like stenting. All had a very good angiographic outcome with TIMI 3 flow and MBG &gt;/= 2. In most patients with acute STEMI and high-grade thrombus, direct or direct-like stenting is possible, it simplifies the procedure with almost nil on table complications.  Twee table abstract  Direct and direct-like stenting in patients with high grade thrombus with STEMI is possible in most of the patients. It resulted in TIMI 3 flow and MBG 2 in all our patients. None of them had no-reflow phenomenon.  Lay AbstractIn any case of ST-elevation MI, time is one of the most important aspects. In this process, it is important to minimize the damage to the heart muscle. Therefore, we need to open the culprit artery in a timely and urgent fashion to restore the blood flow to the heart muscle as quickly as possible. During this restoration of the blood flow, we need to minimize the distal embolization of the clot which may be detrimental to the heart muscle. Here, we describe the cases where we have done stenting directly without touching the clot and that resulted in minimal embolization and better outcomes.

Direct or Direct-Like Stenting in Acute Stemi with High-Grade Thrombus: A Clinical Case Series