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Late coronary stent infection: a difficult to diagnose rare complication after percutaneous coronary intervention

  • Dhiren ShahEmail author
  • Milan Chag
  • Deepa Shah
  • Dhaval Naik
  • Amit Chandan
  • Chintan Sheth
  • Niren Bhavsar
  • Hiren Dholakiya
  • Parloop Bhatt
Case report
  • 16 Downloads

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) with drug-eluting stent placement is a well-established treatment modality for coronary stenotic lesions. Although infection involving implanted stent is rare, it can occur at any point of time, leading to high morbidity and mortality. We describe a rare case of infected coronary stents complicated with recurrent stent thrombosis, sepsis, and myocardial abscess formation after 2 years of percutaneous cornary intervention (PCI). Using multi-modality imaging final diagnoses to evaluate the precise location, extent and morphology of myocardial abscess (MA) was done. “On pump” coronary artery bypass graft (CABG) was performed, left anterior descending (LAD) artery intramyocardially was opened up, about 7–10 ml of pus was evacuated, and two drug-eluting stents (DES) were removed. The isolated identified organism was Pseudomonas aeruginosa which had remained dormant and restricted to the stent area for almost 2 years thinning the myocardium; an unusual trait of a very virulent bacterium which otherwise spreads fast to cause septicemia. The present case exemplifies the high index of clinical sensitivity with early multi-modality diagnosis, aggressive medical therapy, multidisciplinary care, and timely surgical intervention saving the patient’s life in otherwise fatal condition.

Keywords

Stent infection Myocardial abscess Cardiac magnetic resonance imaging 

Notes

Author’s contribution

Each author has contributed significantly to this submitted work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this case were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent

Informed consent was obtained from the patient to publish this report for academic interest.

References

  1. 1.
    Iqbal J, Ahmed I, Baig W. Metastatic myocardial abscess on the posterior wall of the left ventricle: a case report. J Med Case Rep. 2008;2:258.  https://doi.org/10.1186/1752-1947-2-258.CrossRefGoogle Scholar
  2. 2.
    Elieson M, Mixon T, Carpenter J. Coronary stent infections-a case report and literature review. Tex Heart Inst J. 2012;39:884–9.Google Scholar
  3. 3.
    Bosman WM, Borger van der Burg BL, Schuttevaer HM, Thoma S, Hedeman Joosten PP. Infections of intravascular bare metal stents: a case report and review of literature. Eur J Vasc Endovasc Surg. 2014;47:87–99.CrossRefGoogle Scholar
  4. 4.
    Morris TC, Davies O, Bradlow WM, Jeffery K, Bowler ICJW. Endovascular stent-associated infection with Staphylococcus lugdunensis. BMJ Case Rep. 2013;2013:bcr2012008357.CrossRefGoogle Scholar
  5. 5.
    Chakrabarti J. Diagnostic evaluation of myocardial abscesses. A new look at an old problem. Int J Cardiol. 1995;52:189–96.  https://doi.org/10.1016/0167-5273(95)02484-0.CrossRefGoogle Scholar
  6. 6.
    Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J. 2007;154:923–8.  https://doi.org/10.1016/j.ahj.2007.06.028. CrossRefGoogle Scholar
  7. 7.
    Campeau R, Ingram C. Perivalvular abscess complicating infective endocarditis: complementary role of echocardiography and indium-111-labeled leukocytes 1. ClinNucl Med. 1998;23:582–4.  https://doi.org/10.1097/00003072-199809000-00003.Google Scholar
  8. 8.
    Bouchart F, Dubar A, Bessou JP, et al. Pseudomonas aeruginosa coronary stent infection. Ann Thorac Surg. 1997;64:1810–3.CrossRefGoogle Scholar
  9. 9.
    Soman R, Gupta N, Suthar M, Sunavala A, Shetty A, Rodrigues C. Intravascular stent-related endocarditis due to rapidly growing mycobacteria: a new problem in the developing world. J Assoc Physicians India. 2015;63:18–21.Google Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Dhiren Shah
    • 1
    • 2
    Email author
  • Milan Chag
    • 3
  • Deepa Shah
    • 4
  • Dhaval Naik
    • 1
  • Amit Chandan
    • 1
  • Chintan Sheth
    • 1
  • Niren Bhavsar
    • 1
  • Hiren Dholakiya
    • 1
  • Parloop Bhatt
    • 5
  1. 1.Department of Cardiac SurgeryCIMS HospitalAhmedabadIndia
  2. 2.Care Institute of Medical SciencesScience City RoadAhmedabadIndia
  3. 3.Department of CardiologyCIMS HospitalAhmedabadIndia
  4. 4.Department of RadiologyCIMS HospitalAhmedabadIndia
  5. 5.Department of PharmacologyL. M. College of PharmacyAhmedabadIndia

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