Coronary Stent Implantation Poses Lifelong Risk of Severe Infection or Even Death

Abstract

Nowadays, percutaneous coronary intervention (PCI) is an established procedure, and annually more than 500,000 coronary stents are implanted in the United States 1). However, most physicians hardly recognize that a coronary stent can be a potential source of infection and that the risk may last for several years. Stent infection is extremely rare and difficult to identify. As a result, delay in definite diagnosis could lead to even death. Mortality rate of coronary stent infection is reported to be as high as 40% even with surgery 2). Therefore, prompt diagnosis is essential to save patients. In this report, we describe a case of stent infection that occurred 8 years after implantation. To our knowledge, this is the longest reported interval between PCI and infection. Unfortunately , as we did not suspect very late stent infection, the true diagnosis was delayed by more than a few weeks despite repeated examinations using multiple imaging modalities. II. Case report A 66-year-old woman with a history of kidney transplantation and coronary disease presented with fever and general fatigue. She was status post repeated PCI with bare-metal stents (BMS) in the right coronary artery (RCA) at the ages of 57 years, 58 years, and 59 years, and drug-eluting stents (DES) in the left anterior descending coronary artery at the age of 57 years. She had been taking immunosuppressant medications (methyl prednisolone, mycophenolate mofetil, and tacrolimus) for 8 years since kidney transplantation. Her temperature was 39.5 °C and she had an elevated white cell count (16,450/μl), C-reactive protein level (19.67 mg/dl), and procalcitonin level (5.23 ng/ml). Blood cultures grew Staphylococcus aureus sensitive to methicillin (MSSA). At this time, whole-body computed tomography (CT) scan could not identify the source of bacteremia (Fig. 1a). On hospital day 2, she complained of difficulty in speaking. She underwent brain magnetic resonance imaging (MRI) that re