Left Anterior Descending Coronary Artery Stent Infection by Pantoa Agglomerans

Abstract

Background & Purpose: Coronary stent infection is a rare complication post percutaneous coronary intervention (PCI) and associated with high mortality rate (40%-65%). The most common isolated pathogen is Staphylococcus aureus . We report a challenging case of Pantoea agglomerans infection leading coronary stent infection with mycotic aneurysm.

Methods: Single case report and systemic literature review on coronary stent infection. Clinical, imaging, microbiology Data collected from hospital records.

Case description: A 58-year-old male with a history of diabetes, hypertension, hyperlipidemia, and prior PCI to left anterior descending (LAD) presented with exertional and postprandial chest pain. Coronary angiography revealed double vessel disease and an aneurysmal LAD. Transesophageal echocardiography showed LVEF of 40% with anterior and lateral wall hypokinesia. CABG was performed with SVG grafts to OM1cx, OM2cx, D2, and LIMA to distal LAD, along with repair of a post-stent mycotic aneurysm and stent removal. Sputum culture revealed Pantoea agglomerans, sensitive to multiple antibiotics. The patient had an uneventful recovery and was managed with antibiotics therapy.

Results: In a systematic review, only 79 cases of coronary stent infection reported. Stent infections are rare but serious complications, often arising from inadequate aseptic technique, local site infections, or post-procedural issues such as hematomas and pseudoaneurysms following PCI. Management typically involves a combination of medical therapy and targeted antibiotics, though surgical intervention may be necessary in select cases. Due to its infrequency, diagnosis is often delayed which can adversely affect patient outcomes.

Conclusion: Our case highlights a rare association of Pantoea agglomerans infection in LAD stent complicated with mycotic aneurysm managed with surgical intervention and antibiotic therapy. We had favorable outcome due to early recognition of this rare complication.