Coronary Stent Implantation Poses Lifelong Risk of Severe Infection or Even Death

Abstract

On hospital day 2, she complained of difficulty in speaking. She underwent brain magnetic resonance imaging (MRI) that re-Case Coronary stent infection is extremely rare and difficult to identify. Delay in definite diagnosis often leads to death. We describe a case of stent infection that occurred 8 years after implantation. A 66-year-old woman was admitted to our hospital with high-grade fever. She underwent placement of a bare-metal stent to the right coronary artery at 59 years of age. She also underwent kidney transplantation at 58 years of age and had been taking multiple immunosuppressants. Although whole-body computed tomography (CT) scan at the time of admission found no source of bacterial infection, blood cultures grew Staphylococcus aureus . Brain magnetic resonance imaging revealed multiple cerebral infarctions. Infective endocarditis (IE) was suspected but transthoracic and transesophageal echocardiogram found no evidence of IE. The patient became afebrile after administration of intravenous antibiotics and intravenous immunoglobulin, and blood cultures were negative. However, echocardiogram revealed a decline in left ventricle function, and thereafter, the patient developed acute inferior wall myocardial infarction. Urgent coronary angiography exhibited a large coronary artery aneurysm at the origin of the right coronary artery where a previous coronary stent was implanted, and repeat CT also confirmed a very rapidly developing coronary aneurysm. We performed emergent removal of the mycotic aneurysm along with the infected stent. However, the right heart had been severely damaged prior to surgery. She underwent four days of veno-arterial extracorporeal membrane oxygenation but developed bacterial pneumonia and expired on postoperative day 15. This case highlights the long-term risk of coronary stent infection several years after implantation.