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Late Silent Stent Abscess.
Dmitry Zateyshchikov1, Elvira Fattakhova, Vladimir Demchinsky
1Cardiology Department, City Hospital No. 17, Moscow, Russia.
Cardiology
|June 13, 2015
Summary
Stent abscesses are rare but deadly complications. This case highlights the potential for silent, delayed stent abscesses, especially with non-compliance, suggesting a need for increased vigilance.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Coronary stent infections, particularly stent abscesses (SAs), are rare but life-threatening complications.
- SAs typically present within 30 days post-intervention with fever and chest pain, necessitating antibiotic treatment and stent removal.
Observation:
- A 45-year-old male with ST-elevated myocardial infarction and cardiogenic shock died after fibrinolytic therapy.
- Autopsy revealed a previously stented right coronary artery with a significant stent abscess (SA) and complete occlusion of the left main coronary artery.
- The patient had a history of non-compliance with medical advice post-stenting.
Findings:
- A rare case of a late-presenting, silent stent abscess (SA) was discovered post-mortem.
- The SA was characterized by purulent material completely occluding the stent within the coronary artery.
- Patient's gross non-compliance with dual anti-platelet therapy may have contributed to the development of the delayed SA.
Implications:
- The incidence of silent, delayed SAs may be underestimated given the prevalence of coronary angioplasty.
- Clinicians must maintain a high index of suspicion for SAs, even in the absence of typical symptoms.
- Enhanced monitoring of existing stents during repeat interventions and patient adherence to therapy are crucial for preventing such complications.
