Coronary Wall Structural Changes in Patients With Kawasaki Disease: New Insights From Optical Coherence Tomography (OCT)

Abstract

BackgroundCoronary artery aneurysms (CAA) are serious complications of Kawasaki disease (KD). Optical coherence tomography (OCT) is a high-resolution intracoronary imaging modality that characterizes coronary artery wall structure. The purpose of this work was to describe CAA wall sequelae after KD.Methods and ResultsKD patients scheduled for routine coronary angiography underwent OCT imaging between March 2013 and August 2014. Subjects’ clinical courses, echocardiography, and coronary angiography examinations were reviewed retrospectively. OCT was performed in 18 patients aged 12.4±5.5 years, 9.0±5.1 years following onset of KD. Of those, 14 patients (77.7%) had a history of CAA (7 with giant CAA and 7 with regressed CAA at time of OCT). Intracoronary nitroglycerin was given to all patients (88.4±45.5 μg/m2). Mean radiation dose was 10.9±5.2 mGy/kg. One patient suffered from a transitory uneventful vasospasm at the site of a regressed CAA; otherwise no major procedural complications occurred. The most frequent abnormality observed on OCT was intimal hyperplasia (15 patients, 83.3%) seen at both aneurysmal sites and angiographically normal segments amounting to 390.8±166.0 μm for affected segments compared to 61.7±17 μm for unaffected segments (P<0.001). Disappearance of the media, and presence of fibrosis, calcifications, macrophage accumulation, neovascularization, and white thrombi were seen in 72.2%, 77.8%, 27.8%, 44.4%, and 33.3% of patients.ConclusionsIn this study, OCT proved safe and insightful in the setting of KD, with the potential to add diagnostic value in the assessment of coronary abnormalities in KD. The depicted coronary structural changes correspond to histological findings previously described in KD.

Fatal Kawasaki disease with incomplete criteria: Correlation between optical coherence tomography and pathology

“…Difficulties of OCT in children are related to the small size of the vessels. In our experience, some modifications to adapt the technique to this population were made successfully, such as the use of 5 Fr guiding catheters rather than the typical 6 Fr catheters . Although our youngest patient was 3.5 years old, OCT remains hazardous, and impossible in infants such as in the present case, mainly due to the prohibitive small femoral arteries and the inherent risk involved in inserting a 5 Fr catheter.…”

Coronary artery calcification score and common iliac artery calcification score in non‐dialysis CKD patients

“…Unexpectedly, the eGFR and the serum phosphate level were found to be significantly associated with the CACS, but not the IACS in the current study. Further studies using other imaging techniques such as vascular ultrasonography and optical coherence tomography are necessary to confirm whether renal function is related to intimal calcification, medial calcification, or both in CKD patients.…”

Intracoronary Imaging

“…IVUS and OCT are the only in vivo techniques able to determine the nature of the arterial dilatation, therefore discriminating between true aneurysms and pseudoaneurysms 111. The inflammatory changes post Kawasaki have been shown to promote early atherosclerotic changes 112 113. Finally, IVUS offers cross-sectional images of coronary arteries with anomalous origin/course or of the LM compressed by dilatation of the pulmonary trunk in pulmonary hypertension and their possible implications in impairing myocardial perfusion 114…”