Coronary Artery Pseudoaneurysm Complicated by Purulent Pericarditis Treated with Covered Stent

A Case Report

Abstract

This report describes a unique case of a 75-year-old man who developed a coronary artery pseudoaneurysm as a late complication of methicillin-susceptible Staphylococcus aureus (MSSA)-induced purulent pericarditis. The pseudoaneurysm was found to have originated at the proximal edge of a bare-metal stent that had been implanted in the left anterior descending artery 17 years prior to this presentation. The patientʼs initial symptoms included fever and back pain that rapidly progressed to severe sepsis and cardiac tamponade. This necessitated multiple open chest surgical interventions to drain the pericardium and evacuate a significant hematoma. Despite these efforts, a coronary pseudoaneurysm was diagnosed on the 47th day of hospitalization using computed tomography angiography and subsequently confirmed using coronary angiography and intravascular ultrasound. Considering the patientʼs extensive history of thoracic surgery, a less invasive endovascular approach was deemed preferable. Consequently, a covered stent was successfully deployed to exclude coronary pseudoaneurysms effectively. Following intervention and continued targeted antibiotic therapy directed against MSSA, the patient demonstrated significant clinical improvement. He was eventually discharged in a stable condition on the 81st day of hospitalization. This case highlights the rare and complex interplay between purulent pericarditis and the development of coronary artery pseudoaneurysms, particularly as a late complication in patients with prior coronary stenting. Furthermore, it highlights the potential utility and success of endovascular treatment as a viable and less invasive therapeutic strategy in carefully selected high-risk patients where the underlying infection is adequately controlled.