无支架准分子激光消蚀术治疗合并再生障碍性贫血和血小板减少症的急性心肌梗死
Stent-Free Excimer Laser Atherectomy in AMI With Aplastic Anemia and Thrombocytopenia.
作者信息
Ma Yuehua, Zhang Qinping, Wang Wei, Gao Lei
机构信息
Department of Cardiovascular Medicine, Xinxiang Central Hospital, Xinxiang, Henan, China.
Department of General Practice, Chinese People's Liberation Army Unit 66284 Hospital, Beijing, China.
出版信息
JACC Case Rep. 2025 Aug 6;30(22):104658. doi: 10.1016/j.jaccas.2025.104658.
BACKGROUND
Acute myocardial infarction (AMI) complicated by aplastic anemia with severe thrombocytopenia presents a therapeutic dilemma because of conflicting bleeding and thrombotic risks.
CASE SUMMARY
A 60-year-old man with aplastic anemia (platelet count: 28-32 × 10/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.
DISCUSSION
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.
TAKE-HOME MESSAGES: 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.
背景
急性心肌梗死（AMI）合并再生障碍性贫血伴严重血小板减少症，由于出血和血栓形成风险相互矛盾，带来了治疗难题。
病例摘要
一名60岁再生障碍性贫血患者（血小板计数：28 - 32×10/L），伴有ST段抬高型心肌梗死，接受了准分子激光冠状动脉斑块旋切术（ELCA）联合无支架策略。冠状动脉造影显示多支血管病变，右冠状动脉完全闭塞。ELCA减轻了血栓负荷，恢复了TIMI血流3级，且避免了双联抗血小板治疗的需要。随访证实血管持续通畅，无出血并发症。
讨论
本病例突出了ELCA在解决血栓负荷方面的有效性，同时规避了双联抗血小板治疗及支架相关风险，填补了严重血小板减少症患者急性心肌梗死治疗方面的文献空白。
要点
无支架的ELCA方法可安全地恢复血小板减少性急性心肌梗死患者的冠状动脉血流，平衡血栓溶解和出血风险。该策略为传统治疗方法禁忌的高危病例提供了范例。
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