Very Late Mycotic Pseudoaneurysm Associated With Drug-Eluting Stent Fracture

A 72-year-old woman with diabetes mellitus and end-stage ischemic heart disease was admitted to the hospital because of an episode of unstable angina. She had undergone coronary artery bypass graft surgery 4 years earlier with sequential left internal mammary artery to left anterior descending and diagonal artery, and saphenous vein graft to left marginal artery. Seven months after surgery, because of disease progression, she underwent a percutaneous coronary intervention with rotational atherectomy and a 3.5×32 mm paclitaxel-eluting stent implantation at the right coronary artery. During the following years, the patient had several admissions for unstable angina. A new angiography showed a diffusely diseased native vessel, an occluded saphenous graft to the marginal, a patent sequential left internal mammary artery graft to left anterior descending and diagonal artery, and persistence of the good result of the stent implanted in the right coronary artery. Because of the extension and severity of the coronary artery disease, she had been considered a no-option patient. During the present admission (1-year after the last angiography) she experienced fever and superficial phlebitis secondary to peripheral venous catheter that was treated with cloxacillin for 10 days. Five weeks later she was readmitted for persistent …