Stent-Free Excimer Laser Atherectomy in AMI With Aplastic Anemia and Thrombocytopenia

Acute myocardial infarction (AMI) complicated by aplastic anemia with severe thrombocytopenia presents a therapeutic dilemma because of conflicting bleeding and thrombotic risks. A 60-year-old man with aplastic anemia (platelet count: 28-32 × 109/L) and ST-segment elevation myocardial infarction underwent excimer laser coronary atherectomy (ELCA) combined with a stent-free strategy. Coronary angiography revealed multivessel disease with total right coronary artery occlusion. ELCA reduced thrombus burden, restored TIMI flow grade 3, and avoided the need for dual antiplatelet therapy. Follow-up confirmed sustained patency and no bleeding complications. This case highlights the efficacy of ELCA in resolving thrombotic burden while circumventing dual antiplatelet therapy and stent-related risks, addressing a literature gap in managing AMI with severe thrombocytopenia. ELCA with a stent-free approach safely restores coronary flow in patients with thrombocytopenic AMI, balancing thrombus resolution and bleeding risks. This strategy offers a paradigm for high-risk cases where conventional therapies are contraindicated.