An infected coronary artery stent; complicated by stent thrombosis followed by coronary artery perforation

Approximately 5 million percutaneous coronary interventions are performed worldwide annually. Stent-related complications occur at a fairly low rate. The presented case describes a rare infection-related complex complications of percutaneous coronary interventions. A 46-year-old non-diabetic mail developed a fever of unknown origin after six days from the initial Percutaneous Coronary Intervention and was treated empirically with antibiotic therapy without suspicion on any iatrogenic infection. After two weeks from initial percutaneous coronary interventions a patient complained chest pain and with; stent thrombosis segment elevation myocardial infarction diagnoses were readmitted at our hospital. Early stent thrombosis was diagnosed by coronary angiography followed by second percutaneous coronary interventions. After some hours from the second angioplasty procedure acute stent thrombosis was developed. Coronary angiography revealed multiple extravasations on the site of thrombosis complicated with cardiac tamponade. A patient was urgently transferred to a cardiac operation theater. A Pseudomonas Aeruginosa (multiresistant) - was positive after coronary wall tissue histomorphological examination. The fever manifestation must be considered in the differential diagnosis during one or two weeks after initial percutaneous coronary interventions. Diagnosis is based on positive blood cultures and is helpful to manage treatment strategy