Б
том ХXXI, 2025, № 2
ДРУЖЕСТВО
НА КАРДИОЛОЗИТЕ
В БЪЛГАРИЯ
КЛИНИЧНИ СЛУЧАИ
CASE REPORTS
I
Pe cu aneous co ona y in e en ion is he mains ay
in he managemen o co ona y a e y disease. While
his in e en ional p ocedu e has signi i can ly imp o ed
pa ien ou comes, i is no wi hou complica ions. Co -
ona y s en in ec ion (CSI) is a a e bu po en ially a al
complica ion cha ac e ized by colonizing bac e ia o
o he mic oo ganisms on he s en su ace. I is known
o occu in < 0.1% o indi iduals wi h s en s [1]. Gi en
he high mo bidi y and mo ali y associa ed wi h CSI,
a mul idisciplina y app oach in ol ing specialis s om
ca diology, in ec ious disease, and ca diac su ge y is
essen ial o op imal pa ien managemen .
SUCCESSFUL MANAGEMENT OF A RARE CASE OF INFECTED CORONARY STENT
SUCCESSFUL MANAGEMENT OF A RARE CASE OF INFECTED CORONARY STENT
AND MYCOTIC ANEURYSM OF THE CORONARY ARTERY
AND MYCOTIC ANEURYSM OF THE CORONARY ARTERY
M. M. Yusu 1, M. P. Doss2, R. Kannaiyan2, R. Valliammai2, A. M. Kuma 1
1Apollo Hospi als G eams Road – Chennai, India
2Apollo Speciali y Hospi als – Chennai, India
УСПЕШНО ЛЕЧЕНИЕ НА РЯДЪК СЛУЧАЙ НА ИНФЕКТИРАН КОРОНАРЕН СТЕНТ
УСПЕШНО ЛЕЧЕНИЕ НА РЯДЪК СЛУЧАЙ НА ИНФЕКТИРАН КОРОНАРЕН СТЕНТ
И МИКОТИЧНА АНЕВРИЗМА НА КОРОНАРНАТА АРТЕРИЯ
И МИКОТИЧНА АНЕВРИЗМА НА КОРОНАРНАТА АРТЕРИЯ
М. М. Юсуф1, М. П. Дос2, Р. Канайян2, Р. Валиамай2, А. М. Кумар1
1Болници Аполо, Гриймс Роуд – Ченай, Индия
2Специализирани болници Аполо – Ченай, Индия
Abs ac . S en in ec ion is a a e bu se ious complica ion ha can lead o signi i can mo bidi y and mo ali y. A 75-yea -old man wi h
a known his o y o diabe es unde wen pe cu aneous co ona y in e en ion (PCI) o co ona y a e y disease in ol ing he
igh co ona y a e y (RCA). The pa ien p esen ed o ou hospi al wi h s en in ec ion and a subsequen pseudoaneu ysm
o ma ion in he RCA. A mul idisciplina y eam decided on su gical in e en ion o manage s en - ela ed in ec ion. In ec ed
s en s we e emo ed, he pseudoaneu ysm was excised, and he RCA was ein o ced. Addi ionally, he ao ic al e was
inspec ed and deb ided. This case highligh s he in ica e managemen o complex co ona y s en in ec ions and he
impo ance o a imely and coo dina ed mul idisciplina y app oach.
Кey wo ds: co ona y a e y disease, s en , in ec ion
Add ess
o co espondence: Aishwa ya Mahesh Kuma , MD, e-mail: [email p o ec ed]
Резюме.Инфекцията на стента е рядко, но сериозно усложнение, което може да доведе до значителна заболяемост и
смъртност. 75-годишен мъж с известна анамнеза за диабет е претърпял перкутанна коронарна интервенция (PCI)
за коронарна артериална болест, включваща дясната коронарна артерия (RCA). Пациентът постъпи в нашата
болница с инфекция на стента и последващо образуване на псевдоаневризма в RCA. Мултидисциплинарен екип
взе решение за хирургична интервенция за лечение на инфекция, свързана със стента. Инфектираните стентове
бяха отстранени, псевдоаневризмата бе изрязана и RCA беше подсилена. Освен това аортната клапа беше ин-
спектирана и дебридирана. Този случай подчертава трудното лечение на сложни сърдечно-съдови инфекции и
значението на навременния и координиран мултидисциплинарен подход.
Ключови думи:коронарна артериална болест, стент, инфекция
Адрес
за кореспонденция:д-р Айшвария Махеш Кумар, e-mail: [email p o ec ed]
This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (CC BY 4.0), which pe mi s un es ic ed
use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce a e c edi ed.
doi: 10.3897/bgca dio.31.e147010
123
Success ul managemen o a a e case o in ec ed co ona y s en ...
C P
A 75-yea -old man wi h a his o y o diabe es melli-
us p esen ed wi h acu e co ona y synd ome in Feb u-
a y 2024 and unde wen pe cu aneous co ona y in e -
en ion (PCI) o s enosis o he igh co ona y a e y
(RCA) a an ou side hospi al. One week pos -PCI, he
de eloped ecu en e e and was admi ed mul iple
imes and ea ed wi h In a enous an ibio ic he apy.
Subsequen ly, he pa ien was e e ed o ou hospi al
due o a pe sis en e e . On e alua ion, ans ho ac-
ic echoca diog aphy e ealed a mobile mass a ached
o he non-co ona y cusp o he ao ic al e, aising
conce ns o in ec i e endoca di is o s en - ela ed in-
ec ion. Compu ed omog aphy co ona y angiog am
e ealed he p esence o a la ge pseudo-aneu ysm in
he p oximal/mid-sec ion o he s en ed RCA wi h su -
ounding aneu ysmal abscess ca i y (Fig. 1). Blood
cul u es g ew Pseudomonas ae uginosa, leading o a
diagnosis o co ona y s en in ec ion complica ed by
a myco ic aneu ysm o he RCA. A mul idisciplina y
eam mee ing in ol ing a ca diologis , ca dio ho acic
su geon, in ec ious disease specialis , and physician
was con ened, and he decision was aken o pe o m
su gical in e en ion. This was con eyed o he pa ien
and his amily, who we e in o med o he high p oce-
du e isk. Unde gene al anes hesia, median s e no o-
my was pe o med, and he pa ien was placed on ca -
diopulmona y bypass wi h ao a-bica al cannula ion.
Saphenous ein g a was anas omosed dis ally o he
le an e io descending a e y and dis al igh co o-
na y a e y a e enda e ec omy. The ao a was hen
c oss-clamped, and ca dioplegia was gi en o a es
he hea . The p oximal RCA was opened and he in-
ec ed s en s emo ed (Fig. 2). The myco ic aneu ysm
was excised om he igh co ona y a e y, and he ab-
scess ca i y was clea ed. The laid open p oximal RCA
was hen ein o ced wi h Te l on pledge s. Ao o omy
was pe o med o inspec he ao ic al e. The ao ic
al e was inspec ed and ound o be clea o in ec ion.
Fig. 1. Compu ed omog aphy co ona y angiog am e ealed he p esence o a la ge pseudo aneu ysm in he p oximal/mid s en ed RCA wi h
su ounding aneu ysmal abscess ca i y
Fig. 2. In aope a i e image showing emo al o he in ec ed s en
M. M. Yusu , M. P. Doss, R. Kannaiyan e al.
124
Howe e , some calcium deposi s we e emo ed. The
hea was hen ewa med and es a ed. The pa ien
was weaned off ca diopulmona y bypass. The pa ien
made a s eady eco e y wi h an une en ul pos ope a-
i e pe iod and was discha ged home on he 8 h pos -
ope a i e day. The pa ien is on egula moni o ing and
emains symp om- ee a 7-mon h ollow-up.
D
Co ona y s en in ec ions a e a a e bu se ious com-
plica ion ollowing co ona y a e y s en ing. I was i s
epo ed by Gun he in 1993 [2]. Despi e ad ancemen s
in s en echnology and in e en ional ca diology, his
condi ion emains a signi i can clinical challenge. The
exac mechanisms unde lying co ona y s en in ec ion
a e no ully unde s ood, bu se e al ac o s a e implica -
ed. In ec ed co ona y s en s commonly con ain S aphy-
lococcus au eus (80%) and Pseudomonas ae uginosa
(20%) [2]. These bac e ia adhe e o he s en su ace,
o ming a bio i lm. This bio i lm p o ides a p o ec i e en i-
onmen o bac e ial g ow h and esis ance o an ibio -
ics. The implan a ion o a o eign body (s en ) igge s an
in l amma o y esponse. This c ea es a a o able en i-
onmen o bac e ial coloniza ion and bio i lm o ma ion.
A ecen sys ema ic e iew ound ha d ug-elu ing s en s
(DES) we e he mos equen ly epo ed s en s associ-
a ed wi h in ec ions, ollowed by ba e me al s en s and
a combina ion o d ug-elu ing and ba e me al s en s [3].
The ise in DES-associa ed in ec ions is mos likely due
o hei immunomodula o y eff ec s [4]. S en mal-appo-
si ion, h ombus o ma ion, and dis u bed blood l ow can
con ibu e o he de elopmen o in ec ion by c ea ing a -
eas o s asis whe e bac e ia can accumula e. O he isk
ac o s include poo s e ili y, epea ed use o he local
si e o s en placemen , epea ed e-use o ha dwa e
such as balloons, ca he e s, mul iple guidewi e manipu-
la ions, and p olonged indwelling ca he e iza ion [5]. Pa-
ien s ypically p esen wi h ecu en o pe sis en ches
pain, e e , ele a ed in l amma o y ma ke s (C- eac i e
p o ein, e y h ocy e sedimen a ion a e), and signs o
sys emic in ec ion. Symp oms usually appea wi hin
a week a e he p ocedu e, and mos diagnoses a e
made wi hin a mon h o he in e en ion. Myco ic in ec-
ions a e seen in 60% o cases [6]. The diagnosis o co -
ona y s en in ec ion is challenging due o i s a i y and
nonspeci i c symp oms. Clinical suspicion is wa an ed. A
diagnosis may be conside ed i a leas h ee o he ol-
lowing condi ions exis ed: ecen co ona y s en implan-
a ion (< 4 weeks), epea ed p ocedu es using he same
a e y access poin , signs o in ec ion wi hou ano he
explana ion, symp oms o a hea a ack, and abno mal
hea esul s om imaging es s [7]. The managemen
o co ona y s en in ec ion equi es a mul idisciplina y
app oach. Choice o an ibio ic he apy is based on cul-
u e. An i-in l amma o y and an ipla ele agen s a e used
o p e en s en h ombosis. S en emo al o exchange
may be conside ed. The mo ali y associa ed wi h co -
ona y s en in ec ion anges om 40-65%; some cases
may necessi a e immedia e su gical in e en ion [8].
Ou pa ien was managed wi h su gical emo al o he
in ec ed s en and bypass using a saphenous enous
g a . P e en ion o co ona y s en in ec ions hinges on
igo ous adhe ence o asep ic p o ocols h oughou he
p ocedu e and me iculous pos -p ocedu al ca e. Du ing
he in e en ion, s ic s e ile p ac ices, including p ope
hand hygiene, s e ile d aping, and he use o s e ilized
equipmen , a e pa amoun . Minimizing p ocedu al du-
a ion and main aining glycemic con ol u he educes
in ec ion isk. Pos -p ocedu e, me iculous wound ca e,
pa ien adhe ence o an ipla ele he apy, and igilan
moni o ing o signs o in ec ion such as e e and ches
pain a e necessa y. Ea ly de ec ion o in ec ed s en s,
i any, h ough blood cul u es and imaging echniques,
eg, compu ed omog aphy and magne ic esonance im-
aging, coupled wi h a mul idisciplina y app oach in ol -
ing ca diologis s, su geons, in ec ious disease special-
is s, and mic obiologis s, ensu es p omp managemen .
In se e e cases, immedia e su gical in e en ion wi h
b oad-spec um an ibio ic co e age may be necessa y.
C
This case highligh s he se e e and po en ially a al
consequences o co ona y s en in ec ion, emphasizing
he need o ea ly diagnosis, p omp mul idisciplina y
managemen , and agg essi e su gical in e en ion.
Comple e emo al o he s en and he in ec ed ca i y
is essen ial o a success ul ou come.
Re e ences
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2. Gün he HU, S upp G, Volma J e al. Co ona y s en
implan a ion: in ec ion and abscess wi h a al ou come. Z Ka di-
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3. Su yawan IGR, Luke K, Agus ian o RF, Mulia EPB. Co ona y
s en in ec ion: a sys ema ic e iew. Co on A e y Dis. 2022;33(4):318-
326. doi:10.1097/MCA.0000000000001098.
4. Bosman WM, Bo ge an de Bu g BL, Schu e ae HM e
al. In ec ions o in a ascula ba e me al s en s: a case epo and
e iew o li e a u e. Eu J Vasc Endo asc Su g. 2014;47:87-89.
5. Reddy KVC, Sanzgi i P, Thanki F, Su a kal V. Co ona y
s en in ec ion: In e es ing cases wi h a ied p esen a ion. J Ca di-
ol Cases. 2018;19(1):5-8. Published 2018 Sep 12. doi:10.1016/j.jc-
case.2018.08.004.
6. Ramakuma V, Thaku A, Abdulkade RS e al. Co ona y
S en In ec ions – A Sys ema ic Re iew and Me a-Analysis. Ca dio-
asc Re asc Med. 2023;54:16-24. doi:10.1016/j.ca e .2023.02.021.
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2000;23(11):808-810. doi:10.1002/clc.4960231129.
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No con l ic o in e es was decla ed
