ABSTRACT Thrombosis of atherosclerotic coronary is the final common pathway of its occlusion and responsible for acute coronary syndromes. The distal microembolization of atherosclerotic debris and aggregates of platelets are related to myocardial tissue damage even after re-acquiring the patency of the epicardial culpritartery by angioplasty and are related to inadequate distal flow and incomplete resolution of ST segment on the electrocardiogram as well as influencing the evolution of outcomes as reinfarction, ventricular dysfunction, hemodynamic instability and death. Coronary angiography has low sensitivity for detecting thrombus but when it is visualized in the angiography it has a high risk of fragmentation and embolization to the distal bed of the culprit artery or to another branch, and also of thrombosis after stent implantation through angioplasty and commitment of the lumen and coronary flow. We pursued in this article to review the mechanisms of coronary microembolization, adverse events related to this embolization and the interference in coronary flow as well as the prevention of it by using devices for the prevention of coronary embolization distal to the culprit coronary lesion and effects of adjunctive pharmacological treatment and the angioplasty in the interference of coronary blood flow and tissue injury.