Stent Infection Leading to Coronary Aneurysm and Coronary Cameral Fistula.

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.