Coronary Endarteritis Secondary to Stent Infection, a Rare but Catastrophic Complication of Percutaneous Coronary Intervention: A Case Series and Review of Literature

Coronary stent infection (CSI) is a rare but fatal complication of percutaneous coronary intervention (PCI) occurring in less than 0.1% cases. CSI usually manifests as fever and acute coronary syndrome but in some cases presentation may be confusing. Without prompt diagnosis and appropriate treatment, the outcome is poor with mortality reaching 30%. Here, we present 5 cases of CSI resulting in coronary artery aneurysms. Interestingly, CSI occurred during the first stent implantation, mostly in post-acute myocardial infarction patients. Blood culture, pericardial fluid analysis, and coronary angiogram were used as diagnostic tools in our cases. Three of our patients had infective endocarditis involving native mitral and aortic valves and one patient had pericardial effusion and cardiac tamponade. Stent thrombosis and aneurysm formation were observed in all cases. All patients received appropriate and adequate antibiotic therapy before undergoing coronary angiogram and surgery. Cardiac catheterization laboratory hardware reuse, repeated procedures, complex procedures requiring instrumentation, and prolonged indwelling catheters may increase the risk of bacteremia and stent infection. Currently, there are no established criteria or protocols for diagnosis and management of CSI.