Infected Coronary Artery Aneurysm

BACKGROUND: Coronary artery aneurysms are uncommon complications of percutaneous coronary intervention (PCI), and infected aneurysms are rarer still. CASE SUMMARY: A 41-year-old man presented with significant weight loss, recurrent chest pain, and fever spikes lasting for 3 months. Three weeks before symptom onset, he had undergone PCI with a drug-eluting stent placed in the right coronary artery (RCA). Two-dimensional echocardiography and cardiac magnetic resonance imaging revealed a mass anterior to the heart with stent in situ. After taking antibiotics for 6 weeks, the patient underwent excision of the mass containing the stent, thrombus, and inflammatory tissue. As the distal segment of the RCA was thrombosed, ligation or bypass grafting was not possible. Postoperatively, the patient improved dramatically. DISCUSSION: Coronary artery aneurysms are rare complications of PCI, more prevalent after biodegradable stents than drug-eluting stents. While life-threatening complications do exist, the decision of medical versus surgical management rests in the hands of multidisciplinary team members and must be made on a case-by-case basis. TAKE-HOME-MESSAGE: It is important to approach weight loss and recurrent fevers after PCI with a high index of suspicion.