Successful management of a giant unruptured mycotic coronary artery aneurysm after coronary angioplasty

Abstract

Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm, myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Introduction of drug-eluting stent (DES) has led to a marked reduction in the problem of in-stent restenosis across all patient subsets and lesions complexities. Recently, several case reports of pseudoaneurysm formation after DES implantation have been reported in the literature. We describe the successful surgical management of giant mycotic pseudoaneurysm of left anterior descending artery (LAD) presenting as fever of unknown origin. This report illustrates the importance of early detection and prompt management of these rare coronary pseudoaneurysms, which is a highly lethal condition.

Keywords: Mycotic coronary artery aneurysm.

Fig. 1

CT angiography showing large aneurismal cavity with narrow neck.

Fig. 2

Conventional catheter angiography showing dye from LAD entering into aneurysm. Two stents are also visible.

Fig. 3

Intraoperative TEE showing large aneurysm abutting LV wall.

Fig. 4

Intraoperative view of opened coronary aneurysm.

Fig. 5

The covered stent recovered from aneurysm cavity.