Coronary Artery Perforation Complicated by Pericardial Abscess Formation: A Clinical Dilemma.

Abstract

Coronary artery perforation is a rare complication of percutaneous coronary intervention, which occurs in 0.1% to 3% of cases.1 An infrequent cause of coronary artery perforation is stent infection, 80% of which are because of Staphylococcal aureus .2 This is a case of a S. aureus pericardial abscess discovered in the setting of a late left anterior descending (LAD) coronary artery perforation and the potential explanations for this rare presentation. Reports of sepsis after coronary stent implantation, leading to coronary artery aneurysm formation or perforation,3,4 and of purulent pericarditis after percutaneous coronary intervention are exceedingly rare.5–7 This is a rare first report of a pericardial abscess found in conjunction with a perforated coronary artery. A 75-year-old man with a history of hypertension and hyperlipidemia presented to another hospital with upper back pain and electrocardiographic evidence for an ST-segment–elevation myocardial infarction. Coronary angiography revealed a proximal 90% occluded calcified LAD lesion, which was treated with a 2.5×18 mm drug-eluting stent (Figure 1), aspirin, and ticagrelor. A transthoracic echocardiogram demonstrated an ejection fraction of 50% and anterior wall hypokinesis with no significant valvular lesions. Postprocedural shortness of breath developed and was attributed to ticagrelor, which was replaced with clopidogrel. Despite this, he continued to complain of shortness of breath. Nine days after initial presentation with an ST-segment–elevation myocardial infarction, the patient returned to the same hospital for evaluation of his shortness of breath, and a repeat echocardiogram was performed that demonstrated a large pericardial effusion. Pericardiocentesis produced 500 cc of bloody fluid. His shortness of breath improved, and he was discharged home. Figure 1. A , A 90% proximal, calcified left anterior descending lesion was seen on the initial coronary angiogram. B , The lesion was successfully treated with a 2.5×18 mm drug-eluting stent. Several days …