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Kumar SS, Suresh S, Iliyas M, Vijay J, Pillai V. A case report of left circumflex stent infection and mycotic aneurysm: a rare but life-threatening complication of percutaneous coronary intervention. Egypt Heart J 2024; 76:8. [PMID: 38280011 PMCID: PMC10821850 DOI: 10.1186/s43044-024-00442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
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. CASE PRESENTATION 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.
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Affiliation(s)
- Swasthi S Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Sumanyu Suresh
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Mohamed Iliyas
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India.
| | - Jyothi Vijay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Vivek Pillai
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
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Ramakumar V, Thakur A, Abdulkader RS, Claessen B, Anandaram A, Palraj R, Aravamudan VM, Thoddi Ramamurthy M, Dangas G, Senguttuvan NB. Coronary Stent Infections - A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:16-24. [PMID: 36906449 DOI: 10.1016/j.carrev.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Coronary stent infection (CSI) represents a rare but potentially fatal complication of percutaneous coronary interventions (PCI). A systematic review and meta-analysis of published reports was performed to profile CSI and its management strategies. METHODS Online database searches were performed using MeSH and keywords. The primary outcome of the study was in-hospital mortality. A unique Artificial Intelligence-based predictive model was developed for need for delayed surgery and probability of survival on medical therapy alone. RESULTS A total of 79 subjects were included in the study. Twenty eight (35.0 %) patients had type 2 diabetes mellitus. Subjects most commonly reported symptoms within the first week of the procedure (43 %). Fever was the most common initial symptom (72 %). Thirty eight percent of patients presented with acute coronary syndrome. The presence of mycotic aneurysms was described in 62 % of patients. Staphylococcus species were the most common (65 %) isolated organism. The primary outcome of in-hospital mortality was seen in a total of 24 patients out of 79 (30.3 %). A comparative univariate analysis comparing those encountering in-hospital mortality versus otherwise revealed the presence of structural heart disease (83 % mortality vs 17 % survival, p = 0.009), and the presence of non ST elevation acute coronary syndrome (11 % mortality vs 88 % survival, p = 0.03), to be a statistically significant factor predicting in-hospital mortality. In an analysis between patients with successful versus failed initial medical therapy, patients from private teaching hospitals (80.0 % vs 20.0 %; p = 0.01, n = 10) had a higher survival with medical therapy alone. CONCLUSION CSI is a highly under-studied disease entity with largely unknown risk factors and clinical outcomes. Larger studies are needed to further define the characteristics of CSI. (PROSPERO ID CRD42021216031).
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Affiliation(s)
| | - Abhishek Thakur
- Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal
| | | | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Raj Palraj
- Mayo Clinic College of Medicine, Rochester, USA
| | | | | | - George Dangas
- Icahn School of Medicine, Mount Sinai, New York, USA
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3
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Coronel-Meneses D, Sánchez-Trasviña C, Ratera I, Mayolo-Deloisa K. Strategies for surface coatings of implantable cardiac medical devices. Front Bioeng Biotechnol 2023; 11:1173260. [PMID: 37256118 PMCID: PMC10225971 DOI: 10.3389/fbioe.2023.1173260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Cardiac medical devices (CMDs) are required when the patient's cardiac capacity or activity is compromised. To guarantee its correct functionality, the building materials in the development of CMDs must focus on several fundamental properties such as strength, stiffness, rigidity, corrosion resistance, etc. The challenge is more significant because CMDs are generally built with at least one metallic and one polymeric part. However, not only the properties of the materials need to be taken into consideration. The biocompatibility of the materials represents one of the major causes of the success of CMDs in the short and long term. Otherwise, the material will lead to several problems of hemocompatibility (e.g., protein adsorption, platelet aggregation, thrombus formation, bacterial infection, and finally, the rejection of the CMDs). To enhance the hemocompatibility of selected materials, surface modification represents a suitable solution. The surface modification involves the attachment of chemical compounds or bioactive compounds to the surface of the material. These coatings interact with the blood and avoid hemocompatibility and infection issues. This work reviews two main topics: 1) the materials employed in developing CMDs and their key characteristics, and 2) the surface modifications reported in the literature, clinical trials, and those that have reached the market. With the aim of providing to the research community, considerations regarding the choice of materials for CMDs, together with the advantages and disadvantages of the surface modifications and the limitations of the studies performed.
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Affiliation(s)
- David Coronel-Meneses
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
| | - Calef Sánchez-Trasviña
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
| | - Imma Ratera
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Instituto de Salud Carlos IIIBellaterra, Spain
| | - Karla Mayolo-Deloisa
- Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Mexico
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Centro de Biotecnología-FEMSA, Monterrey, Mexico
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, Bellaterra, Spain
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4
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Jaleel J, Kaushik P, Patel C, Chandra KB, Yadav S, Siddharthan D. Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Cardiac Infections. Indian J Nucl Med 2023; 38:140-144. [PMID: 37456185 PMCID: PMC10348497 DOI: 10.4103/ijnm.ijnm_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 07/18/2023] Open
Abstract
Diagnosis of cardiac infections, which includes infective endocarditis (IE) and cardiac device infections, despite having a high death rate, is still challenging. Frequently used modalities such as echocardiography, computed tomography (CT), and magnetic resonance imaging cannot confirm the presence of an active infection or extracardiac findings. Taking these things to consideration, newer guidelines have suggested the inclusion of 18F fluorodeoxyglucose positron emission tomography/CT (18F FDG PET/CT) in the workup of patients with suspected prosthetic valve IE. In this pictorial essay, we are demonstrating the utility of 18F-FDG PET/CT in varied cases of IE, cardiac implantable electronic devices, and coronary stent infection and how they helped in solving diagnostic dilemmas.
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Affiliation(s)
- Jasim Jaleel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kaushik
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Siddharthan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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5
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Kunioka S, Tadokoro N, Fujita T, Fukushima S. Successful exclusion of left main trunk coronary artery aneurysm and concomitant HeartMate 3 implantation in a patient with a history of infective endocarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad080. [PMID: 36909834 PMCID: PMC9994585 DOI: 10.1093/ehjcr/ytad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/12/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
Background Coronary artery embolism is a rare, life-threatening complication in patients with infectious endocarditis. Percutaneous transluminal coronary angioplasty is a common treatment; however, a coronary artery aneurysm may develop at the angioplasty site. Case summary A 33-year-old women had been hospitalized in another institution due to cardiopulmonary arrest caused by embolic occlusion in the left main artery and infective endocarditis on mitral valve. Following extracorporeal membrane oxygenation insertion, she underwent percutaneous transluminal coronary angioplasty of the left main coronary artery and mitral valve replacement. She was transferred to our institution for advanced heart failure care. We immediately upgraded extracorporeal membrane oxygenation to an extracorporeal left ventricular assist device. Despite 6-week adequate medication, her left ventricular function was not improved. She was listed for heart transplantation on post-operative Day 40. Her blood culture showed negative results for 6 weeks. We planned to convert the left ventricular assist device from extracorporeal to implantable. However, pre-operative coronary artery angiography showed a large left main trunk coronary artery aneurysm on the stent site and rapid aneurysm enlargement. Surgery was performed on post-operative Day 48; the aneurysm was left unresected; its inflow and outflow arteries were completely ligated and supplemented by coronary artery bypass grafting. HeartMate 3 was implanted concomitantly, and the post-operative course was uneventful. Discussion Coronary artery aneurysm at the angioplasty site was treated with adequate antibiotic therapy and simply ligation of the proximal and distal flow arteries of the aneurysm. Aneurysm ligation reduced invasive surgical procedures and provided time for concomitant surgery.
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Affiliation(s)
- Shingo Kunioka
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan.,Department of Cardiac Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan
| | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan
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6
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Abstract
Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all reported instances are limited to case reports. CSI presents itself in various, often confusing, ways in clinical settings. Therefore, the current systematic review summarizes reports of CSI's clinical presentations, causative pathogens, diagnoses and treatments. This systematic review considered three online databases, using reference lists as an additional source. All case reports or case series with stent infection in the coronary artery were included - however, reviews or commentaries, articles not published in English, and articles mentioning a history of hemodialysis or any surgery were excluded. Thirty-two studies on 34 CSI patients were included in the final qualitative analysis. CSI predominantly affected males of a wide range of ages. The most common symptoms were chest pain and fever with various onsets. Interestingly, CSI usually occurred during the first stent implantation. Cultures and coronary angiography were the most common methods used to diagnose CSI. Furthermore, drug-eluting stents had a higher risk of infection than bare-metal stents. Aneurysms were the most frequent abnormalities observed in infected stents. The bacteria that most often caused CSI were Staphylococcus aureus and Pseudomonas aeroginosa. More than 90% of the reports mentioned using various antibiotics, and 74% mentioned carrying out surgery. Finally, a mortality rate of 26.47% among CSI patients was calculated.
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Affiliation(s)
- I Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Eka Prasetya Budi Mulia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital
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7
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Wadhokar P, Malani S, Patil R, Nalawade D. Mycotic coronary aneurysm: A rare complication of percutaneous coronary intervention. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Doost A, Rankin J, Yong G. A unique case report of mitral valve endocarditis associated with coronary stent infection. Eur Heart J Case Rep 2021; 5:ytab482. [PMID: 34993407 PMCID: PMC8728727 DOI: 10.1093/ehjcr/ytab482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Despite increasing use of percutaneous coronary intervention and stenting, septic complications such as coronary stent infections are rare. We report a unique case of mitral valve infective endocarditis and associated coronary stent infection which emerged 6 months after index stent insertion.
Case summary
A 56-year-old previously healthy man underwent percutaneous coronary intervention and stenting of left circumflex (LCx) coronary artery in the setting of non-ST-segment elevation myocardial infarction. Six months later, he represented with inferior ST-segment elevation myocardial infarction and was found to have a coronary pseudoaneurysm of stented segment of LCx. The pseudoaneurysm was treated with insertion of a covered stent, and immediately following that he developed sepsis with methicillin-sensitive Staphylococcus aureus bacteraemia. Comprehensive work-up resulted in the diagnosis of mitral valve endocarditis complicated by coronary stent infection and myocardial abscess formation. He was managed with initial prolonged systemic antibiotic treatment followed by mitral valve replacement. Post-operative course was uneventful with a short duration of oral antibiotics. At 6-year follow-up, the patient was well with the satisfactory echocardiographic result.
Discussion
This is a very rare case of mitral valve endocarditis with extensive cardiac involvement including coronary stent infection and surrounding myocardial abscess. Stents can act as an ideal vector for bacterial adherence from which bacteria could spread to the arterial wall and adjacent myocardium. This case suggests a potential complication of delayed endothelialization and risk of infective complication due to bacterial seeding or embolization.
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Affiliation(s)
- Ata Doost
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - James Rankin
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
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9
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Doost A, Ihdayhid AR, Lambert J, Erickson M. Very Late Coronary Stent Infection and Abscess following Staphylococcus aureus Bacteremia. CASE 2021; 5:373-376. [PMID: 34993366 PMCID: PMC8712999 DOI: 10.1016/j.case.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A unique case of S. aureus coronary stent infection occurred 5 years after index PCI. Prompt diagnosis was made with coronary angiography and echocardiography. Successful treatment included prolonged antibiotics and surgical intervention. Delayed coronary stent endothelialization might have contributed to late infection.
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10
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Pisani A, Braham W, Borghese O. Coronary stent infection: Are patients amenable to surgical treatment? A systematic review and narrative synthesis. Int J Cardiol 2021; 344:40-46. [PMID: 34560164 DOI: 10.1016/j.ijcard.2021.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Coronary stent infection is a fearsome complication with high mortality rate. Since antibiotics may have only partial efficacy, invasive surgery may be needed. We present a systematic review about outcomes achieved by surgical versus medical treatment in this scenario. METHODS A literature search through Medline and Google Scholar was performed over a 30-years period according to PRISMA guidelines. Demographics, clinical data, imaging findings and treatment modalities were collected. Outcomes were analysed according to treatment. RESULTS Among 1727 articles identified, after duplicate removal the title/abstract screening excluded 821 articles. After full-text screening, 31 studies were included totalling 34 patients (n 28, 82.4% male, mean age 61.7 SD +/- 10 years old). The majority of infection were sustained by S. Aureus (n 28, 82.4%), occurred within one month (median 7 days, range 1-1440) from stenting and mostly over drug-eluting stents (n21, 61.8%). The majority of patients (n30, 88.2%) underwent antibiotics at first: 12 patients (35.3%) didn't undergo additional treatment because they died, were unfit or refused major surgery or responded favorably to medical treatment; surgery was scheduled in a total of 20 patients (58.8%), as an emergent approach (n2) or after failure of antibiotics (n18). More than half of patients medically treated died (n6/11, 54.5%) versus 35% (n7/20) in surgery group. CONCLUSIONS Coronary stent infections are associated with high morbi-mortality rate. Medical treatment may be the only possible approach in extremely fragile patients, however timely surgical referral is the only definitive treatment, and it is recommended whenever possible.
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Affiliation(s)
- Angelo Pisani
- Department of Cardiovascular Surgery, Pineta Grande Hospital, Castel Volturno, Italy.
| | - Wael Braham
- Department of Cardiovascular Surgery, Bichat Claude Bernard Hospital, Paris, France
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11
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Abe K, Hirai K, Kawasaki T. Stent Fracture Induced Infected Pseudo Coronary Artery Aneurysm with Massive Abscess Successfully Treated by Coronary Stent Graft. Intern Med 2021; 60:1403-1407. [PMID: 33250463 PMCID: PMC8170258 DOI: 10.2169/internalmedicine.5790-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infected pseudo coronary artery aneurysm (CAA) is extremely rare, and currently, there is no established treatment. We experienced a rare case of an infected pseudo CAA brought on due to a stent fracture. Following prolonged successful antimicrobial administration, which proved effective in successfully treating the patient, we performed coronary stent graft placement. Although a surgical procedure should fundamentally be the first course of action considered in such cases, when there are concerns as to the degree of invasiveness, our strategy represents a viable option.
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Affiliation(s)
- Kensho Abe
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
| | - Keisuke Hirai
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
| | - Tomohiro Kawasaki
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
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12
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Ali U, Stamp N, Larbalestier R. Resection of a large mycotic aneurysm of the left anterior descending coronary artery. BMJ Case Rep 2019; 12:12/12/e232894. [PMID: 31818900 DOI: 10.1136/bcr-2019-232894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive S taphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.
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Affiliation(s)
- Umar Ali
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Nikki Stamp
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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13
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Ben Messaoud M, Bouchahda N, Mahjoub M, Hmida B, Dridi Z, Gamra H. Case Report: Coronary artery stent infection with mycotic aneurysm secondary to tricuspid valve infective endocarditis. F1000Res 2019; 8:853. [PMID: 31656587 PMCID: PMC6795233 DOI: 10.12688/f1000research.19067.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/20/2022] Open
Abstract
Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it’s important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution.
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Affiliation(s)
- Mejdi Ben Messaoud
- Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
| | - Nidhal Bouchahda
- Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
| | - Marouane Mahjoub
- Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
| | - Badii Hmida
- Radiology Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
| | - Zohra Dridi
- Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
| | - Habib Gamra
- Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Monastir, Monastir, 5000, Tunisia
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Jiang T, Xie Z, Wu F, Chen J, Liao Y, Liu L, Zhao A, Wu J, Yang P, Huang N. Hyaluronic Acid Nanoparticle Composite Films Confer Favorable Time-Dependent Biofunctions for Vascular Wound Healing. ACS Biomater Sci Eng 2019; 5:1833-1848. [PMID: 33405557 DOI: 10.1021/acsbiomaterials.9b00295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vascular stent implantation is the primary treatment for coronary artery disease. Surface modification of coronary stents is a topic of interest to prevent thrombosis and restenosis and to promote endothelization. However, bioactive coatings on implants have not yet been fully developed for the time-ordered biological requirements of vascular stents. The first month after vascular stent implantation, the pathological changes in the injured vascular tissue are complex and time-ordered. Therefore, vascular stents possess time-dependent biofunctions with early phase anticoagulant and anti-inflammatory properties. In the later stage, inhibitory effects on smooth muscle cell proliferation and the promotion of endothelial cell adhesion might meet the requirements of vascular repair. We fabricated three types of hyaluronic acid nanoparticles (HA-NPs) by subjecting HA and poly(ether imide) to ethyl(dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide coupling reaction. The HA-NPs prepared by HA with a molecular weight of 100 kDa showed the best stability in a hyaluronidase environment. HA-NP composite films (HA-NCFs) were then fabricated by coimmobilizing selected HA-NPs (100 kDa) and HA molecules (100 kDa) through amide reaction on PDA/HD coated 316 L stainless steel surfaces. The detachment behavior of HA-NPs (100 kDa) in PBS for 20 days indicated that the HA-NPs (100 kDa) gradually detached from the surface. In vitro tests (anticoagulant and anti-inflammatory tests, endothelial cells, and smooth muscle cells seeding, and bacterial adhesion test) indicated that the newly fabricated HA-NCFs have inhibitory effects on the adhesion of fibrinogen, platelets, macrophages, bacteria, SMCs, and ECs. As the HA-NPs detached from the surface, the HA-NCFs showed excellent gradual comprehensive biocompatibility, which promoted adhesion and proliferation of ECs while still exerting inhibitory effects on the platelets, macrophages, and SMCs. Finally, in vivo SS wire implantation test (aortic implantation in healthy Sprague-Dawley rats) showed that HA-NCFs possessed anti-inflammatory properties, inhibited the proliferation of smooth muscle cells, and promoted re-endothelialization. In particular, HA-NCFs with time-dependent biofunctions showed better antirestenosis effects than those of surfaces modified with molecular HA, which exhibited constant biocompatibility. This study provides an important basis for the construction of HA-NP composite films with favorable time-dependent biofunctions for the time-ordered biological requirements of vascular stent.
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Affiliation(s)
- Ting Jiang
- School of Life Science and Engineering, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China.,Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Zhou Xie
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Feng Wu
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Jiang Chen
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Yuzhen Liao
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Luying Liu
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Ansha Zhao
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Jian Wu
- School of Life Science and Engineering, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Ping Yang
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
| | - Nan Huang
- Institute of Biomaterials and Surface Engineering, Key Lab. for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, No. 111 of the North First Section of Second Ring Road, Chengdu 610031, PR China
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Buono A, Maloberti A, Bossi IM, Piccaluga E, Piccalò G, Oreglia JA, Moreo A, Russo CF, Oliva F, Giannattasio C. Mycotic coronary aneurysms. J Cardiovasc Med (Hagerstown) 2019; 20:10-15. [DOI: 10.2459/jcm.0000000000000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Shafer K, Toma C, Galdys A. A common pathogen in an uncommon site: coronary artery stent meticillin-resistant Staphylococcus aureus infection. JMM Case Rep 2017; 4:e005110. [PMID: 29114392 PMCID: PMC5642999 DOI: 10.1099/jmmcr.0.005110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Coronary artery stents are an uncommon site for infection. Only a handful of case reports describe this condition, and Staphylococcus aureus is the most frequent pathogen. Although rare, coronary stent infections are associated with a high mortality rate. Case presentation. We describe the case of a 50-year-old man with a past medical history of seven prior meticillin-resistant S. aureus (MRSA) infections over the previous 12 months, who presented with fever and was found to have persistent MRSA bacteraemia. During his hospital course, he developed chest pain and underwent coronary angiography, which revealed a left circumflex coronary to left atrium fistula, presumably due to endarteritis/sent infection. He was treated with combination parenteral antibiotics that were succeeded by oral suppressive therapy. Six months after his diagnosis of coronary stent infection, he suffered a fatal cardiac arrest. Conclusion. Coronary artery stents are an infrequent source of infection; when they occur, they are typically due to S. aureus, have a high mortality and ideally are treated with surgical intervention.
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Affiliation(s)
- Krystle Shafer
- Critical Care Medicine, University of Pittsburgh Medical Center, Suite 1215, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Catalin Toma
- Interventional Cardiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Alison Galdys
- IDIM Division, MMC 250, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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17
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Hammami R, Avran A, Abid L, Kammoun S. [Acute pericarditis and stent infection]. Med Mal Infect 2016; 46:398-399. [PMID: 27368420 DOI: 10.1016/j.medmal.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R Hammami
- Service de cardiologie, hôpital universitaire Hédi Chaker, Sfax, Tunisie.
| | - A Avran
- Institut méditerranéen cœur et vaisseaux, 317, boulevard du redon, 13009 Marseille, France
| | - L Abid
- Service de cardiologie, hôpital universitaire Hédi Chaker, Sfax, Tunisie
| | - S Kammoun
- Service de cardiologie, hôpital universitaire Hédi Chaker, Sfax, Tunisie
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Sekhar S, Vupputuri A, Nair RC, Palaniswamy SS, Natarajan KU. Coronary Stent Infection Successfully Diagnosed Using 18F-Flurodeoxyglucose Positron Emission Tomography Computed Tomography. Can J Cardiol 2015; 32:1575.e1-1575.e3. [PMID: 27106600 DOI: 10.1016/j.cjca.2015.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
Infection of coronary stents is extremely rare. We report a case of a 60-year-old gentleman with recurrent fever after acute stent occlusion and reintervention. A coronary angiogram showed an occluded stented segment and the blood cultures were positive for infection. The presence of inflammation in the stented region was confirmed using 18F-flurodeoxyglucose positron emission tomography computed tomography. The patient underwent surgery and the diagnosis was proven by examination of the surgical material. This article highlights the need to have a high index of suspicion of stent infection, and the use of 18F-flurodeoxyglucose positron emission tomography computed tomography along with coronary angiogram in aiding the diagnosis.
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Affiliation(s)
- Saritha Sekhar
- Department of Cardiology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham University, Kerala, India
| | - Anjith Vupputuri
- Department of Cardiology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham University, Kerala, India
| | - Rajiv Chandrasekharan Nair
- Department of Cardiology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham University, Kerala, India
| | - Shanmuga Sundaram Palaniswamy
- Department of Nuclear Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham University, Kerala, India
| | - Kumaraswamy Uma Natarajan
- Department of Cardiology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham University, Kerala, India.
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20
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Yew KL, Choy CN, Kam JY, Kang Z. Intracoronary blood sampling with a microcatheter for the diagnosis of giant infective coronary aneurysm: Melioidosis of coronary artery mycotic aneurysm. Int J Cardiol 2015; 187:530-1. [PMID: 25863294 DOI: 10.1016/j.ijcard.2015.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kuan Leong Yew
- Cardiology Department, Sarawak General Hospital Heart Center, 94300 Kota Samarahan, Sarawak, Malaysia.
| | - Chun Ngok Choy
- Cardiology Department, Sultanah Aminah Hospital, 80100 Johor Bahru, Johor, Malaysia
| | - Ji Yen Kam
- Cardiology Department, Sultanah Aminah Hospital, 80100 Johor Bahru, Johor, Malaysia
| | - Zarrin Kang
- Cardiology Department, Sarawak General Hospital Heart Center, 94300 Kota Samarahan, Sarawak, Malaysia
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21
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Franco JJ, Abisse SS, Ruisi P, Abbott JD. Infectious complications of percutaneous cardiac procedures. Interv Cardiol 2014. [DOI: 10.2217/ica.14.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Urgent splenectomy in the course of prosthetic valve endocarditis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:205-9. [PMID: 26336422 PMCID: PMC4283872 DOI: 10.5114/kitp.2014.43852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 04/11/2013] [Accepted: 06/24/2013] [Indexed: 11/17/2022]
Abstract
We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, turbulent flow across the aortic prosthesis, which was probably caused by the presence of a pathological smooth and mobile structure (10 × 9 × 5 mm) in front of the aortic annulus. Blood cultures were positive and staphylococcal prosthetic valve endocarditis (PVE) was diagnosed. Despite antibiotic treatment, the patient's condition deteriorated, and he was referred for prosthesis reimplantation. After being transferred to the Cardiac Surgery Clinic, he presented with nausea, vomiting, and abdominal pain. The results of imaging examinations suggested spleen hematoma. The patient underwent an urgent splenectomy. Histopathological examination revealed a spleen infarction consequent to an embolic event and subscapular hematoma. On the 10th day after the laparotomy, cardiac surgery was performed. No large vegetations were found on the aortic prosthesis. The mechanical valve, implanted 20 years earlier, was functioning properly; it was intact and well healed. Several fragments of a thrombus and fibrous tissue, resembling a pannus and covered with minor calcifications, were removed from the ventricular surface of the discs. A decision was reached to leave the aortic prosthesis in situ. The valvular material culture revealed the presence of Streptococcus anginosus, and the antibiotic scheme was modified. The postoperative period was uneventful.
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23
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Gültekin N, Küçükateş E, Bulut G. A Coronary Septic Embolism in Double Prosthetic Valve Endocarditis Presenting as Acute Anteroseptal ST-Segment-Elevation Myocardial Infarction. Balkan Med J 2012; 29:328-30. [PMID: 25207026 DOI: 10.5152/balkanmedj.2012.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 07/04/2012] [Indexed: 11/22/2022] Open
Abstract
Acute myocardial infarction caused by septic embolism is usually fatal. A 40-year-old male patient who presented within 30 minutes of severe chest pain was admitted to the emergency department. An electrocardiogram showed a maximum 6 mm of acute ST elevations at V1-V4 derivations. His body temperature was as high as 38.5ºC. Blood cultures were taken three times before parenteral ampicillin/ sulbactam treatment was administered. Later, coagulase negative staphylococci (Methicillin Sensitive Staphylococcus epidermidis) were identified from his blood cultures. Coronary angiographic examination was performed. Lobulated contours of a septic embolus was shown in the mid region of left anterior descending artery as an outcome. Trans-esophageal echocardiography showed; mobile multiple vegetations on the prosthetic mitral and aorta valves. After six weeks of antibiotherapy, he was completely healed and discharged from hospital.Six months later, he was rehospitalized and died because of complications of recurrent infective endocarditis.
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Affiliation(s)
- Nazmi Gültekin
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul, Turkey
| | - Emine Küçükateş
- Laboratory of Microbiology and Clinical Microbiology, İstanbul University Cardiology Institute, İstanbul, Turkey
| | - Gülsüm Bulut
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul, Turkey
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Elieson M, Mixon T, Carpenter J. Coronary stent infections: a case report and literature review. Tex Heart Inst J 2012; 39:884-889. [PMID: 23304047 PMCID: PMC3528231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although rare, coronary artery stent infections are associated with a high mortality rate. Since the introduction of coronary stents in 1987, only 16 cases of infection have been reported. We report a new case in a 66-year-old woman who had undergone a difficult percutaneous coronary intervention procedure, during which 3 overlapping stents were implanted in the mid portion of the right coronary artery. Twenty-two days after the procedure, the patient died. Autopsy revealed the cause of death to be pericardial tamponade due to rupture of the right ventricular myocardium. The stented portion of the right coronary artery was enveloped by an abscess, and purulent material completely occluded the stents. Cultures of the myocardium were positive for methicillin-resistant Staphylococcus aureus. We conducted a review of the literature on coronary artery stent infections. Data suggest that early-onset infections (<10 days after stent implantation) are potentially amenable to medical therapy alone, but late-onset infections (≥10 days after implantation) or major complications necessitate combined surgical and medical therapy. Medical therapy consists of broad-spectrum antibiotics. Surgical intervention includes stent removal if possible, and abscess drainage or perforation repair when indicated.
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Affiliation(s)
- Marc Elieson
- Department of Internal Medicine, Division of Inpatient Medicine, Scott & White Healthcare/The Texas A&M Health Science Center College of Medicine, Scott & White Memorial Hospital, Temple, Texas 76508, USA
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25
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Luther V, Showkathali R, Gamma R. Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report. J Med Case Rep 2011; 5:408. [PMID: 21864374 PMCID: PMC3177923 DOI: 10.1186/1752-1947-5-408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/24/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. CASE PRESENTATION A 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died. CONCLUSION Clinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed.
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Affiliation(s)
- Vishal Luther
- Department of Medicine, Whittington Hospital NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Refai Showkathali
- Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK, SS16 5NL, UK
| | - Reto Gamma
- Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK, SS16 5NL, UK
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Pseudoaneurysm and coronary abscess secondary to coronary stent fracture identified with Tc-99m hexamethylpropyleneamine oxime-labeled white blood cell SPECT/CT scintigraphy. Clin Nucl Med 2011; 36:397-9. [PMID: 21467866 DOI: 10.1097/rlu.0b013e31820ade7e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Practice Guideline for Adult Antibiotic Prophylaxis during Vascular and Interventional Radiology Procedures. J Vasc Interv Radiol 2010; 21:1611-30; quiz 1631. [DOI: 10.1016/j.jvir.2010.07.018] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 07/03/2010] [Accepted: 07/23/2010] [Indexed: 12/11/2022] Open
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28
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Mijailović ZM, Stajić Z, Jevtić M, Aleksandrić S, Matunović R, Tavciovski D. [Therapeutic approach in patients undergoing percutaneous coronary interventions]. MEDICINSKI PREGLED 2009; 62:331-6. [PMID: 19902784 DOI: 10.2298/mpns0908331m] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While the performance of percutaneous coronary interventions remains the domain of interventional cardiologists, the management of these patients before, during, and after the procedure is in the domain of general cardiologists, internists and primary care physicians. Therefore, for optimal patient care it is crucial that all engaged physicians should understand the procedural risks, complications and optimal treatment strategy before, during and after the procedure. Before a percutanous coronary intervention, patients with known allergies to iodinated contrast dye should be pretreated with oral corticosteroids and H1-receptor blockers. Diabetic patients as well as patients with renal failure need special care. Hydration is crucial for patients with renal insufficiency in order to minimise the risk of contrast nephropathy. Metformin therapy should be discontinued before the procedure in patients with renal failure in order to avoid lactic acidosis, and it should be reinstituted after the procedure only when normal serum creatine level is confirmed. Double antiplatelet therapy (aspirin plus clopidogrel) should be initiated at least six hours before the procedure. While aspirin therapy after the procedure is life long, the duration of clopidogrel therapy depends on the type of implanted stent (in patients with bare stents implanted clopidogrel should be taken at least 3 - 4 weeks post procedural, and in patients with drug-eluting stents implanted clopidogrel should be taken at least 6 - 12 months after the procedure due to in-stent restenosis prevention). Patients who experience typical anginal pain in a period of one to eight month after percutaneous coronary revascularization are likely to have restenosis, and they should be reevaluated with stress echocardiography and/or repeated coronary angiography.
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29
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Infective mycotic aneurysm presenting as transient acute coronary occlusion and infectious pericarditis. South Med J 2009; 102:640-2. [PMID: 19434042 DOI: 10.1097/smj.0b013e3181a1613d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac catheterization carries a negligible risk of bacteremia. Post coronary artery intervention (PCI) bacteremia occurs frequently (in approximately 30% of cases); however, clinical sequelae occur rarely in such cases. Percutaneous coronary intervention has a greater bacteremic potential, probably due to the lengthy procedure time and the repeated insertion of interventional devices into the vascular system. When septic complications do occur after cardiovascular intervention the resulting morbidity and mortality are high and often much accelerated. We present the case of a patient who presumably developed a mycotic coronary artery aneurysm and infective pericarditis after undergoing PCI.
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30
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Salinas G, Kumar D, Lick S, Vijayakumar V, Rahman M, Uretsky BF. Infective coronary aneurysms: a complication of percutaneous coronary intervention. Tex Heart Inst J 2007; 34:91-4. [PMID: 17420801 PMCID: PMC1847918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present the case of a patient who developed infective coronary artery aneurysms after percutaneous coronary artery intervention. We describe the patient's clinical presentation, diagnosis, and treatment, and we review the pertinent medical literature.
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Affiliation(s)
- Guillermo Salinas
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0553, USA
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Abstract
Every interventional procedure can result in infective complications. Generally the incidence is low; however, with newer and more aggressive techniques the infection risk is more prevalent and can result in serious adverse outcomes to our patients. Antibiotic prophylaxis has become commonplace; however, there is little controlled data to underpin our regimens and most choices are based on surgical practice and anecdotal evidence. The rise of antibiotic resistance and treatment of many immunocompromised patients further compounds the difficulties faced. The purpose of this article was to examine the evidence that is presented regarding antibiotic prophylaxis in interventional radiology and highlight how we integrate this into our daily practice. In particular we will focus on evolving procedures and techniques that are associated with a high incidence of infection.
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Affiliation(s)
- P Beddy
- Department of Interventional Radiology, St. James Hospital, Dublin, Ireland
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32
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Cunha BA, Eisenstein LE, Hamid NS. Pacemaker-induced Staphylococcus aureus mitral valve acute bacterial endocarditis complicated by persistent bacteremia from a coronary stent: Cure with prolonged/high-dose daptomycin without toxicity. Heart Lung 2006; 35:207-11. [PMID: 16701116 DOI: 10.1016/j.hrtlng.2005.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 09/10/2005] [Indexed: 10/24/2022]
Abstract
Continuous high-grade Staphylococcus aureus bacteremia suggests acute bacterial endocarditis (ABE), a protected focus, ie, an abscess, or a device-related infection. Daptomycin was curative of S. aureus ABE and coronary stent-related bacteremia. Prolonged high-dose daptomycin therapy (12 mg/kg per day for 41 days) is not associated with any toxicity. Persistent S. aureus bacteremia in ABE should suggest myocardial or perivalvular abscess. If intracardiac abscess can be ruled out and there is no extracardiac source of the S. aureus bacteremia, then a device-related infection should be considered.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA
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Brinker J. Who let the bugs in? Catheter Cardiovasc Interv 2005; 65:286-7. [PMID: 15895414 DOI: 10.1002/ccd.20421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jeff Brinker
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Abstract
Despite several decades of advances in both minimally invasive techniques and antibiotic therapy, infection remains one of the more common complications of invasive procedures. Interventional radiology (IR) has traditionally been believed to be associated with lower infection rates than surgery. However, new interventional techniques, as well as more aggressive therapeutic interventions, have presented new challenges in relation to pharmacological management of postprocedural infection and pain. The risk of infection associated with IR procedures can never be completely eliminated, and the reasons for this are manifold, including more virulent organisms, ongoing and newly emerging antibiotic resistance, increased numbers of immunocompromised patients, and the adoption into everyday interventional practice of more aggressive interventional techniques such as chemoembolization, uterine fibroid embolization, and complex biliary intervention. Despite the widespread use of prophylactic antibiotics in IR, and the widely held belief that they are beneficial and are the standard of care, randomized controlled clinical trials have never validated the use of antibiotics in this setting. As such, an argument could be made not to use antibiotics at all for prophylaxis in IR. The purpose of this article is to discuss some of the issues relating to the use of prophylactic antibiotics, and what choice of antibiotics physicians make when they decide to use prophylaxis for IR procedures.
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Affiliation(s)
- J Mark Ryan
- Division of Vascular-Interventional Radiology, Duke University Medical Center, Durham, NC, USA.
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36
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Bonatti H, Berger T, Waltner-Romen M, Bodner G, Hengster P, Antretter H, Friedrich G. Sternal osteomyelitis complicating percutaneous coronary artery stenting. Wien Klin Wochenschr 2004; 116:404-6. [PMID: 15291295 DOI: 10.1007/bf03040922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hematogenous sternal osteomyelitis is a rare infection that has been associated with i.v drug abuse and blunt thoracic trauma, but iatrogenic infections have also been described following resuscitation and in conjunction with hemodialysis catheters. Staphylococcus aureus is the most common causative organism. Stenting is the preferred treatment for isolated stenosis of the coronary artery and is associated with a low complication rate and high patency rate. Such intravascular procedures are rarely complicated by infections. A 72-year-old man developed hematogenous sternal osteomyelitis following coronary artery stenting. Radiological diagnosis was made using CT scan and MRI, and blood cultures and aspiration fluid from the infected soft tissue were positive for S. aureus. Initial therapy consisted of i.v. second-generation cephalosporin followed by oral cephalexin and later linezolid. Prolonged antibiotic therapy without surgical intervention was successful in controlling this rare complication. The patient was well at the one-year follow up, with patent stent and no signs for recurrent osteomyelitis. Although transcutaneous stenting is a widely accepted strategy for treating stenosed arteries, this case highlights the possibility of hazardous infectious complications associated with such procedures.
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Affiliation(s)
- Hugo Bonatti
- Department of General and Transplant Surgery, Innsbruck University Hospital, Innsbruck, Austria.
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Golubev N, Schwammenthal E, Di Segni E, Pudil R, Hay I, Feinberg MS. Echocardiographic Imaging of Coronary Artery Abscess Following Stent Implantation. Echocardiography 2004; 21:87-8. [PMID: 14717730 DOI: 10.1111/j.0742-2822.2004.03025.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nina Golubev
- Heart Institute, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel.
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39
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Glazier JJ. Interventional treatment of septic coronary embolism: sailing into uncharted and dangerous waters. J Interv Cardiol 2002; 15:305-7. [PMID: 12238428 DOI: 10.1111/j.1540-8183.2002.tb01109.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- James J Glazier
- Cardiac Catheterization Laboratory, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA
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