Coronary Stent Abscess After Percutaneous Coronary Intervention: Diagnostic and Therapeutic Challenges.

backgroundCoronary stent abscess is a rare but potentially fatal complication of percutaneous coronary intervention (PCI), often presenting with nonspecific symptoms and leading to delayed diagnosis. CASE SUMMARY: We report a single-center experience of 5 patients with suspected coronary stent abscess, presenting after PCI with fever and recurrent chest pain. All cases demonstrated a coronary pseudoaneurysm on angiography. Blood cultures were positive in 3 patients. Advanced imaging, including computed tomography and coronary angiography, aided anatomical definition; however, positron emission tomography-computed tomography was nondiagnostic. Three patients underwent surgical intervention with stent removal and coronary artery bypass grafting, whereas one underwent percutaneous covered stent implantation. Two elderly patients with delayed presentation, including one with hemodynamic compromise, died despite aggressive management. DISCUSSION: Coronary stent abscess remains a diagnostic challenge. Early suspicion in post-PCI patients with systemic symptoms supported by multimodality imaging and timely initiation of antibiotic therapy followed by surgical intervention may improve outcomes, particularly in high-risk populations. TAKE-HOME MESSAGES: Coronary stent infection should be suspected in post-percutaneous coronary intervention patients with pseudoaneurysm and systemic symptoms, even when microbiology and positron emission tomography imaging results are negative. Early recognition, prolonged targeted antibiotic therapy, and timely surgical intervention remain central to improving outcomes.