Manual aspiration thrombectomy is reasonable for patients undergoing primary PCI.221,223,234,235 (Level of Evidence: B) and a meta-analysis234 support the use of man- ual aspiration thrombectomy during primary PCI to improve microvascular reperfusion and to decrease deaths and adverse cardiac events. However, infarct size was not reduced by manual aspiration thrombectomy in the INFUSE-AMI (Intra- coronary Abciximab Infusion and Aspiration Thrombectomy in Patients Undergoing Percutaneous Coronary Intervention for Anterior ST-Segment Elevation Myocardial Infarction) trial of patients with large anterior STEMI.223 The trial was underpowered to detect differences in clinical outcomes. No clinical benefit for routine rheolytic thrombectomy has been demonstrated in primary PCI.234,236,237 4.3. Use of Stents in Primary PCI 4.3.1. Use of Stents in Patients With STEMI: Recommendations Class I 1. Placement of a stent (bare-metal stent [BMS] or drug-eluting stent [DES]) is useful in primary PCI for patients with STEMI.238,239 (Level of Evidence: A) 2. BMS should be used in patients with high bleed- ing risk, inability to comply with 1 year of dual an- tiplatelet therapy (DAPT), or anticipated invasive or surgical procedures in the next 1 year. (Level of Evidence: C) Class III: Harm 1. DES should not be used in primary PCI for patients with STEMI who are unable to tolerate or comply with a prolonged course of DAPT because of the increased risk of stent thrombosis with premature discontinua- tion of one or both agents.240 246 (Level of Evidence: B) Coronary stents are used routinely at the time of primary PCI. 