Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm. myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Recently, several case reports of pseudoaneurysm formation after DES implantation have been reported in the literature. We describe the successful surgical management of giant mycotic pseudoaneurysm of RCA presenting as fever of unknown origin with AMI (inferior) three months after multivessel PCI in LAD & RCA with DES in radial route. This report illustrates the importance of early detection and prompt management of these rare coronary pseudoaneurysms, which is a highly lethal condition. At three months follow-up after surgery, the patient was asymptomatic with fair LVEF 58% Bangladesh Heart Journal 2020; 35(1) : 66-70
The management of combined Coronary Artery Disease and Peripheral Vascular Disease is a challenge and brings with it numerous clinical dilemmas. The 56 year old gentleman presented to our department with significant triple vessel disease with occluded lower end of aorta just before bifurcation and occluded bilateral superficial femoral arteries. CABG with aorto-femoral and femoro popliteal bypass was done on the same setting. On 12th postoperative day he was discharged from hospital in good general condition. Follow up after 6 months of operation the patient is doing well and free of chest pain and claudication pain. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22266 Cardiovasc. j. 2015; 7(2): 159-161
BackgroundPost percutaneous coronary intervention peudoaneurysm formation is a rarely reported phenomenon. Pseudoaneurysms, of course, can lead to some adverse outcomes as thrombosis with distal embolization, rupture, and cardiac tamponade. Herein, we describe the case of a patient who experienced pseudoaneurysm formation after deployment of a stent. Methods and materialsA 47years old man presented post PCI (2 stented, RCA and LAD, July 2018) with unstable angina after 4 months history of exertional chest pain, palpitation, respiratory distress on exertion on 09/12/18. His medical history included obesity, dyslipidemia, hypertension, smoking, and a significant family history of early-onset coronary artery disease.On Echocardiogram Mild RWMA seen with LVEF 42%, other parameters were in normal range. Coronary Angiogram revealed a focal stenosis in the proximal RCA and Pseudoanurysm was seen in RCA (Previously stented).The patient was having recurrent chest pain 2 month after the initial percutaneous coronary intervention (PCI), and he was taken for repeat coronary angiography on the day admission. The RCA stent was occluded. However, just outside of the mid-portion of the stent was collection of contrast, which appeared to reveal a pseudoaneurysm.Surgical intervention was done with cardiopulmonary bypass. After Sternotomy, severe dense pericardial adhesion had been seen around the pseudoaneurysdm , adhesion was very carefully dissected, pseudoaneurysm was opened, palpated the stent on RCA, stent had been removed, endarterectomy was done in RCA distal to pseudoaneurysm, 2 small perforation in RCA was repaired by 6-0 polypropylene, RCA proximally and distally ligated with 4-0 polypropylene. Most of the wall of the Pseudoaneurysm had been removed and marsupialization was done. Venous graft was given to distal RCA after long endarterectomy (Figures 1-7). Figure 1 Pseudoaneurysm in RCA (CAG).
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