Discussion
Infective complications are rare after PCI. Less than thirty cases of
coronary stent infection have been reported in the literature, most
occurring during the four weeks following the procedure. In only few
cases it did occur late. Staphylococcus aureus is by far the most common
pathogen causing septic complications after PTCA [1]. Almost all
untreated infected aneurysms in case of stent infection eventually lead
to rupture [2].
Our patient presented seven years after PCI with an epicardial abscess.
The exact mechanism behind this complication remains unclear. The most
likely hypothesis is having bacteraemia that took origin from the
dialysis catheter that seeded in the right coronary stent.
Coronary fistula in stent infection seldom happens. Only two similar
cases were found in the literature [3,4]. Our case was unique in its
late presentation, presence of coronary rupture, infected false
aneurysm, and right atrial fistula formation.
Whatever the mechanism of stent infection is, it is always a
life-threatening condition; all aseptic precautions should be taken to
prevent this iatrogenic infection. We believe that the delay in surgical
therapy in addition to the multiple comorbidities and the poor
hemodynamic status our patient had, resulted in his poor outcome.