Stentitis and Infected Coronary Pseudoaneurysm Post-PTCA and Role of FDG-PET : A Case Report

Coronary artery pseudoaneurysms and stent infections (stentitis) are exceedingly rare complications of PTCA, associated with high morbidity and mortality. This case report is about a 39-year-old male with a history of ACS who underwent PTCA with drug-eluting stent placement to the OM1 artery. Two months later, he presented with symptoms of chest pain, fever, and unstable angina. A pseudoaneurysm was revealed on coronary angiography, and a suspicion of stentitis was raised. Hence, FDG PET-CT was performed after appropriate patient preparation, which revealed a large, partially thrombosed pseudoaneurysm in OM1 with abnormal peripheral FDG uptake, along with increased FDG uptake in the OM1 stent, suggesting an infected stent with a mycotic pseudoaneurysm. Blood cultures grew Pseudomonas aeruginosa. Even after initiation of targeted intravenous antibiotics and planned surgical intervention, the patient still succumbed to fatal hemorrhage from the infected pseudoaneurysm. This case highlights the role of FDG PET-CT in diagnosing coronary stent infections and infected pseudoaneurysms, which remain rare but life-threatening complications of PTCA, requiring early diagnosis and timely intervention to prevent catastrophic outcomes.