Mechanical thrombolysis in acute coronary syndromes is poorly understood and is still considerably underused in interventional cardiology. The authors report 3 cases of thrombotic coronary obstruction successfully treated with the Possis Angiojet system. In the first case, coronary angiography which demonstrated a large subocclusive thrombus in the mid right coronary artery was performed in a patient with unstable angina following acute myocardial infarction. Removal of the bulk of the thrombus through the activation of the Angiojet system allowed safe and direct stenting of the residual obstruction. In the second case, the Angiojet system was used to remove a thrombus which prolapsed within a stent during a primary angioplasty procedure on the left anterior descending coronary artery. The third case demonstrates the efficacy of the Possis Angiojet system in cleaning up an extensively thrombosed vein graft of an elderly patient with acute anterior myocardial infarction and cardiogenic shock. After thrombus debulking and restoration of TIMI 3 flow in the graft and in the native left anterior descending coronary artery, the left ventricular function was restored and the hemodynamic picture improved. This technique, the indications and results of this promising new device are discussed and reviewed in detail.