Ketana Venkata Rajasekhara Rao, Mukherjee Ayindrila, Syeda Sabiha Nigar
Department of Cardio Thoracic and Vascular Surgery, Care Hospital, Exhibition Ground Road, Nampally, Hyderabad, 500001 Telangana India.
Indian J Thorac Cardiovasc Surg. 2025 Jan;41(1):56-60. doi: 10.1007/s12055-024-01732-7. Epub 2024 Apr 25.
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.
冠状动脉支架感染被认为是经皮冠状动脉介入治疗最罕见的并发症，发生率不到0.1%。本文报道了一例冠状动脉支架感染合并急性支架闭塞及周围支架周围冠状动脉脓肿的病例。一名46岁男性于2022年7月11日因过去1周间歇性发热和间歇性胸痛为主诉前来我院急诊科就诊。他于2022年6月20日被诊断为急性下壁和后壁心肌梗死，并在另一家中心接受替奈普酶溶栓治疗后，对右冠状动脉（RCA）植入药物洗脱支架（DES）进行了经皮冠状动脉介入治疗（PCI）。他无糖尿病和高血压病史，PCI术后接受双联抗血小板治疗。就诊时，他焦虑但警觉且配合。他于2022年6月30日接受了冠状动脉造影检查，随后于2022年7月12日进行了计算机断层扫描（CT）冠状动脉造影。最终诊断为RCA急性支架闭塞和支架周围脓肿。术前，他的肝转氨酶升高，轻度中性粒细胞增多，肾功能测试值正常，血培养报告为阴性。他于2022年7月14日接受手术。手术过程包括从RCA取出感染的支架和引流支架周围脓肿。支架和脓液培养对致病微生物的敏感性为阴性。术后，他持续发热，抗生素升级。他还出现了非少尿型急性肾损伤（AKI）和心包炎。他接受了术后并发症的药物治疗，并在最佳药物治疗下出院。随访时，他的肾功能测试显示有所改善，在1年的随访中未出现发热或胸痛复发。
