Stent Infection Leading to Coronary Aneurysm and Coronary Cameral Fistula

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.104125

Sathish Kumar Rentapalla MD , Barun Kumar MD, DM , Anirudh Mukherjee MD, DM , Pradeep Kumar MS, MCH

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Abstract

Background

Coronary stent infection (SI) is a rare but catastrophic complication, occurring in 0.3% to 6% of cases post–percutaneous coronary intervention (PCI). Early diagnosis and surgical interventions are crucial for definitive diagnosis and management.

Case Summary

A 52-year-old man underwent PCI for an inferior wall myocardial infarction to the left circumflex artery (LCx) with a single sirolimus-eluting stent. He developed a fever 10 days later due to methicillin-sensitive Staphylococcus aureus. Imaging showed a coronary cameral fistula with a left atrial appendage (LAA) mycotic aneurysm. He was treated with antibiotics, stent explantation, abscess drainage, and fistula repair; however, he developed refractory vasoplegia and died 2 days post-surgery.

Discussion

Coronary SI requires a high index of suspicion. The use of multimodality imaging and multidisciplinary approaches to diagnose and manage infection is essential. Late and complicated stent infections have a high mortality rate.

Take-Home Messages

Coronary SI is an important differential diagnosis for fever post-PCI. Prompt diagnosis, multimodality imaging, and early intervention are needed.

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支架感染导致冠状动脉瘤和冠状动脉瘤腔内瘘。

背景：冠状动脉支架感染是一种罕见但灾难性的并发症，发生在经皮冠状动脉介入治疗（PCI）后0.3%至6%的病例中。早期诊断和手术干预是明确诊断和治疗的关键。病例总结：一名52岁男性因左旋动脉（LCx）下壁心肌梗死接受PCI治疗，使用单个西罗莫司洗脱支架。10天后因甲氧西林敏感金黄色葡萄球菌发烧。影像学显示冠状动脉摄像瘘管伴左心房附件（LAA）真菌性动脉瘤。他接受抗生素治疗，支架置入，脓肿引流，瘘管修复；然而，他出现难治性血管截瘫，术后2天死亡。讨论：冠状动脉SI需要高怀疑指数。使用多模式成像和多学科方法来诊断和管理感染是必不可少的。晚期和复杂的支架感染具有很高的死亡率。关键信息：冠状动脉SI是pci术后发热的重要鉴别诊断。需要及时诊断、多模式成像和早期干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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