Very late stent thrombosis occurring after drug-eluting stent implantation is a rare complication. However, it is often associated with poor outcome. Manual thrombectomy has been shown to lower the rate of distal embolization in the case of ST-elevation myocardial infarction of native coronary arteries. However, the presence of abundant thrombus material may lead to manual thrombus aspiration failure. Here, we describe the case of a patient with acute myocardial infarction due to stent thrombosis of a sirolimus-eluting stent occurring 50 months after stent deployment showing abundant thrombus material, which led to manual thrombus aspiration failure and was then successfully treated by excimer laser coronary angioplasty. In these cases, excimer laser coronary angioplasty may be useful due to its ability to dissolve thrombus.