Stentocarditis Presenting as a Giant Left Main Coronary Artery Aneurysm: A Case Report

Coronary stent infection is a rare but frequently fatal complication of percutaneous coronary intervention (PCI).Its clinical features are nonspecific, and blood cultures may be negative, so the diagnosis is often delayed.We report the case of a 53-year-old man with diabetes and hypertension who underwent elective PCI of the left main and left anterior descending arteries with a drug-eluting stent for chronic coronary syndrome.Fifteen days later, he presented with fever and chest pain.Coronary angiography showed an aneurysmal left main coronary artery and thrombotic occlusion of the left circumflex artery, which was treated with a second stent.His symptoms persisted, and he was referred to our institution one month after the index procedure with leukocytosis and raised inflammatory markers.Blood cultures drawn before antibiotics were sterile, but 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) showed intense uptake around the stent.Inflammatory markers settled during four weeks of intravenous vancomycin and piperacillin-tazobactam, but repeat angiography showed that the left main aneurysm had enlarged into a giant aneurysm.He underwent coronary artery bypass grafting with a left internal mammary artery graft to the left anterior descending artery.Because the aneurysm wall had begun to calcify, the surgeons judged the risk of rupture to be low and left the aneurysm and stent in situ.His postoperative course was uneventful, and he was discharged in stable condition.This case shows that fever and chest pain in the weeks after PCI should raise suspicion of stent infection, that sterile blood cultures do not exclude it, and that 18F-FDG PET-CT can support the diagnosis.An infected aneurysm that keeps growing despite antibiotic therapy needs surgical review, and the operative strategy can be individualized.