Late coronary stent infection: a difficult to diagnose rare complication after percutaneous coronary intervention

Chag, Milan; Shah, Dhiren; Naik, Dhaval; Chandan, Amit; Sheth, Chintan; Bhavsar, Niren; Dholakiya, Hiren; Bhatt, Parloop

doi:10.1007/s12055-018-0698-z

Cited by 6 publications

(1 citation statement)

References 7 publications

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“…In the present case, DWIBS showed a high signal coinciding with the low-density area of contrast-enhanced CT; however, since the low-density area of CT disappeared afterward, the high signal of DWIBS was considered to indicate acute inflammation rather than a tumor. To date, myocardial abscess has been diagnosed using conventional T1- and T2-weighted imaging in only few cases [ 12 – 18 ]. However, to the best of our knowledge, no study has reported on the diagnosis of isolated myocardial abscesses using DWIBS.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

Nakata

Yokota

Kenzaka

2023

BMC Cardiovasc Disord

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Background Myocardial abscess is often associated with infective endocarditis (IE), and isolated myocardial abscess without IE is rare. Echocardiography and computed tomography (CT) are often used to diagnose myocardial abscess; however, to the best of our knowledge, diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) has not been used. Here, we present a case of myocardial abscess without IE that was diagnosed using DWIBS. Case presentation : A 72-year-old Japanese man with a history of hypertension, dyslipidemia, and retinitis pigmentosa presented to our hospital with malaise and a fever lasting 10 days. Blood test results showed elevated inflammatory marker levels (white blood cell count 18,700/µL and C-reactive protein level 23.0 mg/dL). Infection was suspected; however, the source of the infection could not be identified. DWIBS, which was performed on day 7 of admission to determine the source of infection, showed a high signal surrounding the right wall, suggesting inflammation. Contrast-enhanced CT performed on day 1 of hospitalization revealed a low-density area in the same region; however, the pathological implications of this finding could not be determined. Based on DWIBS findings, we concluded that the condition presented as a myocardial abscess that was confined specifically to the right atrial wall. Three sets of blood cultures revealed negative findings, and echocardiography showed no vegetation or valve regurgitation. Therefore, the patient was diagnosed with an isolated myocardial abscess uncomplicated with IE. An electrocardiogram on admission showed no P waves, and the patient had a junctional rhythm. However, on day 20 of hospitalization, he developed a complete atrioventricular block. After complete myocardial abscess healing following antibiotic treatment was confirmed, the patient underwent pacemaker implantation. Ten months after surgery, the patient had no signs of infection recurrence. Conclusions Based on history and physical examination alone, diagnosis of an isolated myocardial abscess can be challenging. In addition to CT and echocardiography, DWIBS might be helpful for the diagnosis of myocardial abscesses.

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Section: Discussionmentioning

confidence: 99%

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

Nakata

Yokota

Kenzaka

2023

BMC Cardiovasc Disord

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Surgical management of drug-eluting stent associated coronary artery aneurysms: a case series

Sajja¹,

Mannam²,

Kamtam³

2023

Indian J Thorac Cardiovasc Surg

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Coronary Stent Infection: A Systematic Review of Literature

Ayyubi,

Rehman,

Fatima

et al. 2023

Cardiology in Review

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Coronary stent infection is a rare yet serious complication of coronary artery stenting, with potentially significant morbidity and mortality. This systematic review aimed to comprehensively assess the available evidence on the diagnosis, management, and outcomes of coronary stent infection. A comprehensive search of electronic databases, including PubMed, Embase, Cochrane Library, and Scopus, was conducted from inception until March 2023, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1 case series and 41 case reports, covering a cumulative sample size of 44 patients, were included in the analysis. The predominant stent types were drug-eluting stents in 22 studies, bare-metal stents in 3 studies, and a combination of drug-eluting stents and bare-metal stents in 4 studies. Staphylococcus aureus was the predominant identified organism in microbiological profiles. Primary outcomes, including mortality, morbidity, and recurrence rates, were evaluated. The aggregate mortality rate across studies was 18%, underscoring the severity of coronary stent infections. Morbidity ranged from 3% to 60%, with a spectrum of complications such as sepsis, heart failure, and embolic events. Recurrence rates varied from 3% to 33%, emphasizing the importance of effective management. Treatment strategies encompassed antibiotics alone, antibiotics with stent removal, and antibiotics with stent retention, with the duration of antibiotic therapy ranging from 2 weeks to 12 months. The optimal management strategy remains uncertain due to limited high-quality evidence. Early diagnosis and treatment were emphasized as critical factors in improving outcomes. Prophylactic antibiotics during stenting procedures and increased awareness among healthcare providers were suggested as preventive measures.

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Late coronary stent infection: a difficult to diagnose rare complication after percutaneous coronary intervention

Cited by 6 publications

References 7 publications

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

Surgical management of drug-eluting stent associated coronary artery aneurysms: a case series

Coronary Stent Infection: A Systematic Review of Literature

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