Title name-vanishing stent phenomenon on optical coherence tomography in a mycotic coronary aneurysm: a case report

Coronary artery pseudoaneurysm (PSA) is a rare but serious complication following drug-eluting stent implantation. Mycotic aneurysms can develop from coronary stent infections, which, while uncommon, carry high mortality rates. Early diagnosis and intervention are essential for improving outcomes in such cases. This report presents a case of mycotic aneurysm in the left circumflex artery (LCx) following percutaneous coronary intervention (PCI), with the 'vanishing stent phenomenon' observed on optical coherence tomography (OCT).

A 62-year-old male was admitted with fever and chest pain 1 week after PCI of the LCx and left anterior descending artery using drug-eluting stents. Despite empirical antibiotic treatment, his fever and chest pain persisted, prompting further investigations. Positron emission tomography-computed tomography (PET-CT) scan revealed significant uptake of fluoro-deoxy-glucose around the LCx stent, suggestive of infection. Coronary angiography revealed a coronary PSA at the LCx stent site, with OCT showing damaged, disappeared and displaced stent struts, known as the 'vanishing stent phenomenon.' The patient was diagnosed with stent infection and mycotic aneurysm. He was treated with intravenous antibiotics, followed by successful surgical removal of the infected stent, repair of the PSA, and coronary artery bypass grafting. The patient's post-operative course was uneventful and he was discharged in stable condition.

This case highlights the importance of timely diagnosis and management in coronary stent infections. The 'vanishing stent phenomenon' on OCT demonstrated severe infection-related stent damage. PET-CT, OCT imaging, and prompt surgical with antibiotic interventions were crucial in treating this life-threatening complication, emphasizing vigilance after PCI for persistent symptoms.