Coronary stent infection and acute stent occlusion with peri-stent abscess: a case report

Abstract

Coronary stent infection is considered the rarest complication of percutaneous coronary intervention, occurring in less than 0.1% of the cases. In this article, a case of coronary stent infection and acute stent occlusion with surrounding peri-stent coronary abscess has been reported. A 46-year-old male presented to the emergency at our centre on 11/07/2022 with chief complaints of intermittent fever spikes and intermittent chest pain since the past 1 week. He had been diagnosed with acute inferior and posterior wall myocardial infarction on 20/06/2022 and had undergone percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation to the right coronary artery (RCA) following thrombolysis with tenecteplase at a different center. He was non-diabetic and non-hypertensive and on dual antiplatelet therapy post PCI. On presentation, he was anxious but alert and cooperative. He underwent check coronary angiogram on 30/06/2022 followed by a computerized tomography (CT) coronary angiogram on 12/07/2022. He was finally diagnosed with acute stent occlusion and peri-stent abscess in RCA. Preoperatively, he had raised liver transaminases, mild neutrophilic leukocytosis with normal renal function test values, and a negative blood culture report. He was operated on 14/07/2022. Surgical procedure included infected stent retrieval from RCA and peri-stent abscess drainage. Stent and pus culture sensitivity was negative for causative microorganisms. Post surgery, he had continued fever spikes and antibiotics were escalated. He also developed non-oliguric acute kidney injury (AKI) and pericarditis. He was treated medically for the post-op complications and was discharged on optimal medical management. On follow-up visits, his renal function tests showed improvement and there was no recurrence of fever or chest pain in 1-year follow-up.

Keywords: Acute coronary stent thrombosis; Coronary stent infection (CSI); Early−onset CSI; Epicardial ultrasound; Sterile pus; Surgical management of CSI.

Fig. 1

CT coronary angiogram images of occluded stent

Fig. 2

Peri-stent abscess

Fig. 3

Epicardial ultrasound images of stent in RCA

Fig. 4

Infected stent removed in toto