2-016 Case report: a case of infected coronary artery aneurysm- an unusual complication of PCI

Introduction A coronary artery aneurysm (CAA) is the focal dilatation of an arterial segment to greater than 1.5-times of the adjacent normal vessel. Coronary aneurysms are uncommon complications of percutaneous coronary intervention (PCI) and infected aneurysms are rarer still. Studies describe their potential to lead to serious sequelae such as aneurysmal rupture, local thrombosis, distal embolization and even arrhythmias or heart failure. Case Report We present an unusual case of a 41-year-old man with significant weight loss, recurrent chest pain and fever spikes for 3 months. Three weeks prior to symptom onset, the patient had undergone a PCI with a drug eluting stent placed in the right coronary artery (RCA). The patient had a background of diabetes, hypertension and had deranged renal parameters on admission. Elevated inflammatory markers and a PET scan showing increased FDG uptake in the proximal RCA along the stent with multiple mediastinal lymph nodes, raised the suspicion of a stent infection. A non-contrast cardiac MRI later confirmed the diagnosis of a large infected coronary aneurysm post RCA stenting. The patient had received several courses of oral antibiotics earlier and has been started on intravenous antibiotics for 6 weeks, with a plan for surgical intervention. He is to undergo a CABG with bypass graft to distal RCA or ligation of the proximal RCA and exclusion of the aneurysm. Conclusion Although uncommon, infected coronary aneurysm remains a serious condition with high morbidity and mortality rates. More than a quarter of patients do not survive past the five-year mark after being diagnosed with CAAs. Therefore, we believe it is paramount that seemingly unrelated symptoms such as weight loss and recurrent fever are approached with a high index of suspicion in patients who have undergone cardiac intervention in the past.