Mechanical Thrombus Aspiration for a Young STEMI Patient With Plaque Erosion: Time for a Stent-Free Approach?

A 34-year-old man with no cardiovascular history presented with anterior ST-elevation myocardial infarction and a large thrombotic occlusion of the mid left anterior descending artery. Following potent antithrombotic therapy and mechanical thrombus aspiration, angiography revealed vessel patency without residual significant stenosis, allowing a deferred stent strategy. Subsequent optical coherence tomography confirmed definite plaque erosion, supporting conservative management with dual antiplatelet and intensive lipid-lowering therapy. At 1-year follow-up, the patient remained asymptomatic with no adverse events, underscoring the feasibility of an imaging-guided, stent-free approach in selected young patients with erosion-related acute coronary syndromes.