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Abstract：
BACKGROUND: Coronary stent infections are an uncommon but deadly complication of percutaneous coronary intervention. Mortality remains as high as 40-60% even with adequate treatment. We report such an interesting case of left circumflex stent (LCX) infection and mycotic aneurysm that was successfully managed with antibiotics and surgery.
METHODS: A middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.
CONCLUSIONS: It is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.
METHODS: A middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.
CONCLUSIONS: It is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.
摘要：
背景：冠状动脉支架感染是经皮冠状动脉介入治疗的一种罕见但致命的并发症。即使经过适当的治疗，死亡率仍高达40-60％。我们报告了这样一个有趣的左回旋支架（LCX）感染和霉菌性动脉瘤病例，该病例已通过抗生素和手术成功治疗。
方法：一名中年男子在四周前对左回旋支动脉进行了经皮冠状动脉介入治疗（PCI），被称为不明原因发热病例。对抗生素没有反应，和秋水仙碱开始怀疑德雷斯勒综合征。尽管炎症标志物升高，血培养结果没有任何生长。超声心动图显示左房室沟有可疑的回声结构和轻度心包积液，怀疑是支架感染。PET扫描显示LCX支架区域的局灶性代谢活动，伴有代谢活跃的锁骨上和气管旁淋巴结，冠状动脉造影显示动脉瘤出现在带支架的LCX远端。诊断为支架感染和相关的真菌动脉瘤，病人接受了手术，包括动脉瘤修复，支架取回,和冠状动脉旁路移植术（CABG）到主要和终末OM。术后进展顺利，患者出院，无并发症。
结论：研究PCI术后长期发热个体冠状动脉支架感染的可能性非常重要。当超声心动图不确定时，PET扫描和冠状动脉造影可以帮助诊断。适当的抗生素治疗和及时的手术对于成功管理冠状动脉支架感染至关重要。
方法：一名中年男子在四周前对左回旋支动脉进行了经皮冠状动脉介入治疗（PCI），被称为不明原因发热病例。对抗生素没有反应，和秋水仙碱开始怀疑德雷斯勒综合征。尽管炎症标志物升高，血培养结果没有任何生长。超声心动图显示左房室沟有可疑的回声结构和轻度心包积液，怀疑是支架感染。PET扫描显示LCX支架区域的局灶性代谢活动，伴有代谢活跃的锁骨上和气管旁淋巴结，冠状动脉造影显示动脉瘤出现在带支架的LCX远端。诊断为支架感染和相关的真菌动脉瘤，病人接受了手术，包括动脉瘤修复，支架取回,和冠状动脉旁路移植术（CABG）到主要和终末OM。术后进展顺利，患者出院，无并发症。
结论：研究PCI术后长期发热个体冠状动脉支架感染的可能性非常重要。当超声心动图不确定时，PET扫描和冠状动脉造影可以帮助诊断。适当的抗生素治疗和及时的手术对于成功管理冠状动脉支架感染至关重要。
