Infected Left Anterior Descending Artery Stent with Coronary Pseudoaneurysm Acting as Sole Distal Flow: A Rare Cause of Tamponade and Emergency Coronary Artery Bypass Graft

Background Coronary stent infection with pseudoaneurysm is an exceptionally rare but life-threatening complication of percutaneous coronary intervention requiring emergency management. Case Presentation A 52-year-old man with diabetes and hypertension underwent percutaneous coronary intervention to the proximal left anterior descending artery for anterior wall myocardial infarction. Weeks later, he presented with fever and dyspnea. Computed tomography angiography revealed complete left anterior descending stent occlusion and a large pseudoaneurysm communicating with the distal left anterior descending, acting as its sole perfusion source. He developed hemopericardium and tamponade, necessitating emergency drainage and on-pump coronary artery bypass grafting with a saphenous vein graft to the left anterior descending, stent removal, and proximal left anterior descending ligation. The patient had an uneventful recovery. Conclusions Clinicians must be vigilant about post-percutaneous coronary intervention fever. Early imaging, clinical suspicion, and timely intervention are life-saving.