Coronary Artery Rupture Caused by Stent Infection
2015; Lippincott Williams & Wilkins; Volume: 131; Issue: 14 Linguagem: Inglês
10.1161/circulationaha.114.014328
ISSN1524-4539
AutoresApostolos Roubelakis, John Rawlins, Giedrius Baliulis, Sally Olsen, Simon Corbett, Markku Kaarne, Nick Curzen,
Tópico(s)Cardiovascular Issues in Pregnancy
ResumoHomeCirculationVol. 131, No. 14Coronary Artery Rupture Caused by Stent Infection Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBCoronary Artery Rupture Caused by Stent InfectionA Rare Complication Apostolos Roubelakis, PhD, John Rawlins, MD, MRCP, Giedrius Baliulis, MD, Sally Olsen, BM, Simon Corbett, PhD, FRCP, Markku Kaarne, MD and Nick Curzen, PhD, FRCP Apostolos RoubelakisApostolos Roubelakis From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). , John RawlinsJohn Rawlins From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). , Giedrius BaliulisGiedrius Baliulis From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). , Sally OlsenSally Olsen From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). , Simon CorbettSimon Corbett From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). , Markku KaarneMarkku Kaarne From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). and Nick CurzenNick Curzen From Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK (A.R., J.R., G.B., S.O., S.C., M.K., N.C.); and Faculty of Medicine, University of Southampton, Southampton, UK (N.C.). Originally published7 Apr 2015https://doi.org/10.1161/CIRCULATIONAHA.114.014328Circulation. 2015;131:1302–1303A 62-year-old man with a history of hypertension was admitted with unstable angina. Three years earlier, he had presented with a non–ST-segment–elevation myocardial infarction and had undergone percutaneous coronary intervention with a paclitaxel-eluting stent (3.0×20 mm; Taxus, Boston Scientific, Boston, MA) to the proximal left anterior descending coronary artery (Figure 1A). His initial ECG was normal, and his biomarkers were not elevated. Eight hours into his admission, he became pyrexial and developed chest pain associated with transient anterior ST-segment elevation. Emergency coronary angiography demonstrated aneurysmal dilatation at the proximal edge of the previous stent (Figure 1B). Because he had normal flow (Thrombolysis in Myocardial Infarction grade 3), his pain had settled spontaneously, and there was no evidence of a left ventricular regional wall motion abnormality (Movie I in the online-only Data Supplement) on transthoracic echocardiography, the supervising cardiologist elected to treat him medically in the first instance, pending administration of antibiotics and discussion about coronary artery bypass graft surgery. He was treated with dual antiplatelet therapy and antibiotics. Multiple blood cultures subsequently grew Staphylococcus aureus (methicillin sensitive) sensitive to flucloxacillin.Download figureDownload PowerPointFigure 1. Series of angiographic stills. A, The drug-eluting stent in the proximal left anterior descending artery (box) after the initial percutaneous coronary angiography. B, Aneurysmal dilatation at the proximal stent edge (box) on this presentation. C, Rapid progression with rupture 12 hours later.A few hours later, having continued to have a high temperature, he developed further chest pain and ST-segment elevation with hypotension. An emergency echocardiogram demonstrated a pericardial effusion. Repeat emergency coronary angiography confirmed rupture of the left anterior descending artery aneurysm (Figure 1C), and he was transferred for emergency surgery. At surgery, the left anterior descending artery was exposed (Figure 2A), and the diseased area, including the stent, was resected (Figure 2B–2D). The left internal mammary artery was then grafted to the left anterior descending artery. Postoperative transthoracic echocardiography demonstrated anterior hypokinesia with mild left ventricular systolic impairment (Movie II in the online-only Data Supplement). Tissue cultures confirmed the presence of methicillin-sensitive S aureus sensitive to flucloxacillin. The patient recovered well and was discharged home once he completed a 6-week course of antibiotic treatment, which consisted of intravenous flucloxacillin 2 g every 4 hours and peros fucidic acid 500 mg 3 times a day.Download figureDownload PowerPointFigure 2. Operative images from surgeon's view. A, The area of the infected left anterior descending artery (LAD; circle). B, The incised LAD exposing the stent (circle). C and D, Excised LAD specimen with the stent showing the lack of stent coverage.Percutaneous stent deployment is the commonest modality for coronary revascularization. Infective complications are rare. The first coronary stent infection was described in 1993,1 and since then, <30 cases have been reported.2 Most cases describe early infection, with onset between 2 days and 4 weeks after percutaneous coronary intervention.3 Late infection is rare, with 1 report of stent infection 3 years after intervention associated with stent fracture.2 These cases of stent infection share similar clinical features: fever usually accompanied with an episode of chest pain.4 Diagnosis of stent infection can be challenging. Clinical suspicion should be high in patients with previous intervention, unexplained fever, positive blood cultures, and chest pain. There is no single modality confirming diagnosis, but hematologic cultures, echocardiography, coronary angiography, computed tomography, and magnetic resonance imaging scanning can provide useful information.4 The natural history of stent infection is often catastrophic. Complications may include pericardial empyema, tamponade, coronary vessel perforation, ventricular rupture, and cardiac arrest, in addition to severe sepsis and multiorgan failure. Surgical intervention is usually required, but even after surgery, overall mortality can reach 25% to 50%.4DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.114.014328/-/DC1.Correspondence to Apostolos Roubelakis, PhD, Wessex Cardiac Centre, Southampton University Hospital, Tremona Rd, Southampton, SO16 6YD, UK. E-mail [email protected]References1. Günther HU, Strupp G, Volmar J, von Korn H, Bonzel T, Stegmann T.Coronary stent implantation: infection and abscess with fatal outcome [in German].Z Kardiol. 1993; 82:521–525.MedlineGoogle Scholar2. Del Trigo M, Jimenez-Quevedo P, Fernandez-Golfin C, Vaño E, Delgado-Bolton R, Alfonso F, Gonzalo N, Kallmeyer A, Montes L, Escribano N, Hernandez-Antolin R, Macaya C.Very late mycotic pseudoaneurysm associated with drug-eluting stent fracture.Circulation. 2012; 125:390–392. doi: 10.1161/CIRCULATIONAHA.111.051508.LinkGoogle Scholar3. Kaufmann BA, Kaiser C, Pfisterer ME, Bonetti PO.Coronary stent infection: a rare but severe complication of percutaneous coronary intervention.Swiss Med Wkly. 2005; 135:483–487. doi: 2005/33/smw-11142.MedlineGoogle Scholar4. Elieson M, Mixon T, Carpenter J.Coronary stent infections: a case report and literature review.Tex Heart Inst J. 2012; 39:884–889.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Suryawan I, Luke K, Agustianto R and Mulia E (2021) Coronary stent infection: a systematic review, Coronary Artery Disease, 10.1097/MCA.0000000000001098, 33:4, (318-326), Online publication date: 1-Jun-2022. Cho K, Sunwoo S, Hong Y, Koo J, Kim J, Baik S, Hyeon T and Kim D (2021) Soft Bioelectronics Based on Nanomaterials, Chemical Reviews, 10.1021/acs.chemrev.1c00531, 122:5, (5068-5143), Online publication date: 9-Mar-2022. Pisani A, Braham W and Borghese O (2021) Coronary stent infection: Are patients amenable to surgical treatment? A systematic review and narrative synthesis, International Journal of Cardiology, 10.1016/j.ijcard.2021.09.030, 344, (40-46), Online publication date: 1-Dec-2021. Ben Messaoud M, Bouchahda N, Mahjoub M, Hmida B, Dridi Z and Gamra H (2019) Case Report: Coronary artery stent infection with mycotic aneurysm secondary to tricuspid valve infective endocarditis, F1000Research, 10.12688/f1000research.19067.1, 8, (853) Reddy K.V. C, Sanzgiri P, Thanki F and Suratkal V (2019) Coronary stent infection: Interesting cases with varied presentation, Journal of Cardiology Cases, 10.1016/j.jccase.2018.08.004, 19:1, (5-8), Online publication date: 1-Jan-2019. Davidson L and Ricciardi M (2018) Coronary Artery Perforation Complicated by Pericardial Abscess Formation, Circulation: Cardiovascular Interventions, 11:2, Online publication date: 1-Feb-2018. Elder A, Ho K, Allman K, Lowe H, Amos D and Adams M (2017) What is This Image? 2017: Image 2 Result, Journal of Nuclear Cardiology, 10.1007/s12350-017-1019-4, 24:5, (1512-1514), Online publication date: 1-Oct-2017. Shafer K, Toma C and Galdys A (2017) A common pathogen in an uncommon site: coronary artery stent meticillin-resistant Staphylococcus aureus infection, JMM Case Reports, 10.1099/jmmcr.0.005110, 4:9, Online publication date: 25-Sep-2017. Lai C, Lin Y, Lee W and Chang W (2017) Coronary Stent Infection Presented as Recurrent Stent Thrombosis, Yonsei Medical Journal, 10.3349/ymj.2017.58.2.458, 58:2, (458), . April 7, 2015Vol 131, Issue 14 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.014328PMID: 25847982 Originally publishedApril 7, 2015 PDF download Advertisement SubjectsCardiovascular SurgeryStentTreatment
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