Yusuf Jamal, Gautam Ankur
Department of Cardiology, GB Pant Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India.
Eur Heart J Case Rep. 2025 Apr 5;9(4):ytaf163. doi: 10.1093/ehjcr/ytaf163. eCollection 2025 Apr.
Coronary artery pseudoaneurysm (PSA) is a rare but serious complication following drug-eluting stent implantation. Mycotic aneurysms can develop from coronary stent infections, which, while uncommon, carry high mortality rates. Early diagnosis and intervention are essential for improving outcomes in such cases. This report presents a case of mycotic aneurysm in the left circumflex artery (LCx) following percutaneous coronary intervention (PCI), with the 'vanishing stent phenomenon' observed on optical coherence tomography (OCT).
A 62-year-old male was admitted with fever and chest pain 1 week after PCI of the LCx and left anterior descending artery using drug-eluting stents. Despite empirical antibiotic treatment, his fever and chest pain persisted, prompting further investigations. Positron emission tomography-computed tomography (PET-CT) scan revealed significant uptake of fluoro-deoxy-glucose around the LCx stent, suggestive of infection. Coronary angiography revealed a coronary PSA at the LCx stent site, with OCT showing damaged, disappeared and displaced stent struts, known as the 'vanishing stent phenomenon.' The patient was diagnosed with stent infection and mycotic aneurysm. He was treated with intravenous antibiotics, followed by successful surgical removal of the infected stent, repair of the PSA, and coronary artery bypass grafting. The patient's post-operative course was uneventful and he was discharged in stable condition.
This case highlights the importance of timely diagnosis and management in coronary stent infections. The 'vanishing stent phenomenon' on OCT demonstrated severe infection-related stent damage. PET-CT, OCT imaging, and prompt surgical with antibiotic interventions were crucial in treating this life-threatening complication, emphasizing vigilance after PCI for persistent symptoms.
冠状动脉假性动脉瘤（PSA）是药物洗脱支架植入术后一种罕见但严重的并发症。真菌性动脉瘤可由冠状动脉支架感染发展而来，虽然不常见，但死亡率很高。早期诊断和干预对于改善此类病例的预后至关重要。本报告介绍了一例经皮冠状动脉介入治疗（PCI）后左旋支动脉（LCx）发生真菌性动脉瘤的病例，光学相干断层扫描（OCT）观察到“支架消失现象”。
一名62岁男性在使用药物洗脱支架对LCx和左前降支进行PCI术后1周因发热和胸痛入院。尽管进行了经验性抗生素治疗，但其发热和胸痛仍持续，促使进一步检查。正电子发射断层扫描-计算机断层扫描（PET-CT）显示LCx支架周围氟脱氧葡萄糖摄取显著，提示感染。冠状动脉造影显示LCx支架部位有冠状动脉PSA，OCT显示支架支柱受损、消失和移位，即“支架消失现象”。患者被诊断为支架感染和真菌性动脉瘤。他接受了静脉抗生素治疗，随后成功手术切除感染支架、修复PSA并进行冠状动脉搭桥术。患者术后恢复顺利，出院时病情稳定。
该病例强调了冠状动脉支架感染及时诊断和管理的重要性。OCT上的“支架消失现象”表明存在严重的感染相关支架损伤。PET-CT、OCT成像以及及时的手术联合抗生素干预对于治疗这种危及生命的并发症至关重要，强调PCI后对持续症状的警惕性。
