Infected Coronary Artery Aneurysm Within Chronically Occluded Stents

Infected coronary artery aneurysm (ICAA) is a rare, fatal complication. While usually associated with virulent pathogens, ICAA involving chronic stent occlusion and atypical organisms remains poorly understood.

An 85-year-old immunocompromised woman receiving sarilumab presented with sepsis of unknown focus. The 12-year-old stents in the right coronary artery had been documented as occluded 3 weeks before admission. Despite therapy for Corynebacterium species bacteremia, the patient died of progressive septic shock. Autopsy identified the cause of death as aortic valve infective endocarditis, with secondary ICAA involving the right coronary artery ostium and the occluded stented segment. Histology showed transmural abscess formation and dense neutrophilic infiltration, confirming severe infection and wall destruction within the stented segment.

In immunocompromised patients, infective endocarditis can cause ICAA involving even chronically occluded stents, which serve as an isolated site for infection. Implanted devices can become a nidus for fatal complications caused by low-virulence pathogens.