Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Tsuda, Etsuko

doi:10.1017/s104795112000133x

Cited by 5 publications

(2 citation statements)

References 38 publications

(49 reference statements)

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“…If the patient is younger, it may be better to avoid an emergency stent implantation except in life-threatening situations requiring rescue. 15 In our institution, the following factors favour selection of PTCRA for treatment: evidence of ischaemia and single-vessel disease rather than multi-vessel disease, and a limitation of burr size confining the procedure to bigger children. However, if re-vascularisation with CABG rather than the target branch is contemplated, a combined therapy would be useful in patients with multi-vessel disease.…”

Section: Discussionmentioning

confidence: 96%

Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease

et al. 2021

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Thirteen boys and one girl, 5–30 years (median 13 years), underwent percutaneous transluminal coronary rotational atherectomy. The interval from the onset of Kawasaki disease to PTCRA ranged from 5 to 29 years (median 12 years). The follow-up period was 1–22 years (median 13 years). The target vessels were the right coronary artery (7), left anterior descending artery (3), left circumflex (2), and left main trunk (2). The maximum burr size used was 1.75 mm in four, 2.00 mm in four, and 2.15 mm in six. The immediate results of rotational atherectomy were successful in all patients, and the mean stenosis degree improved from 86 ± 15% (mean ± standard deviation) to 37 ± 14% (p < 0.001). Cardiac events in the late period were found in four patients (29%). Acute myocardial infarction occurred in two, and syncope and ventricular fibrillation in one each. The cardiac event-free rate at 10 and 20 years was 79% (95% confidence interval 50–92) and 39% (6–87), respectively, (n = 14). The overall 20-year patency rate was 54% (95% CI 28–78). That in patients more than 10 years old was 77% (95% CI 42–94, n = 10). PTCRA alone is suitable for severe localised stenosis with calcification caused by KD in young adults except for small children. Re-stenosis within the first year after PTCRA often develops because of reactive intimal thickening after the procedure. If a target vessel is a patent 1 year after the procedure, long-term patency may be expected in patients more than 10 years old.

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Section: Discussionmentioning

confidence: 96%

Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease

et al. 2021

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“…In 2020, Tsuda reviewed 33 patients who underwent stent implantations and reported that late-period adverse effects were found in 19 (68%) of 28 vessels with follow-up angiograms. The rate of being free of adverse effects at three years after the procedure was only 25% ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Interventional therapy for coronary artery occlusion in a 6-year-old child with Kawasaki disease

Zhao

Xie

et al. 2022

Front. Pediatr.

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A 6-year-old girl was diagnosed with Kawasaki disease and bilateral giant coronary artery aneurysms at four months old and was subsequently referred to our hospital due to chest pain and T wave changes on electrocardiography. After admission, stress myocardial perfusion imaging showed reversible ischemia in multiple areas of the left ventricle. Coronary angiography revealed complete proximal segment occlusion of the left circumflex artery (LCX). The occluded LCX was recanalized by a Gaia 3rd micro-wire successfully passing through the occluded section to the distal end of the LCX, followed by sequential balloon dilation and drug-coated balloon angioplasty. Coronary angiography immediately after post-dilation and one-year follow-up angiography showed that the structure and blood flow of LCX was good. Although percutaneous coronary intervention (PCI) in pediatric patients with Kawasaki disease is limited in practice, PCI remains one of the treatment options for selected patients.

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Characteristics and outcomes of patients with stent implantation for coronary artery lesions caused by Kawasaki disease – insights from second-generation stent implantation

Ishi,

Tsuda

2024

Cardiol Young

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Background: Adult Kawasaki patients may require intervention for occlusive coronary artery disease. Some adverse effects of first-generation drug-eluting stent implantation with sirolimus have been reported in this population. Methods: A total of nine lesions in eight (seven males, one female) patients who underwent stent implantations in this population between 2000 and 2021 were reviewed. Results: The age at stent implantation ranged from 31 to 47 years, with a median of 37 years. There were six lesions treated by primary percutaneous transluminal coronary interventions, and three by elective procedures. A coronary aneurysm was found in two lesions, and coronary artery calcification was found in all culprit lesions. The numbers of everolimus-eluting stents, sirolimus-eluting stents and bare metal stents were six, two, and one, respectively. As anti- thrombotic therapy, aspirin, clopidogrel, and prasugrel were given to four, three, and one, respectively. Warfarin was given to five patients. The follow-up ranged from 2 to 12 years, with a median of 4 years. Follow-up angiograms were performed for eight lesions, at 2 to 38 months, with a median of 11 months. The patency of the target vessel was confirmed in all eight vessels. Slight malapposition, and peri-stent contrast staining were found in two lesions each. Conclusion: Acute coronary syndrome due to coronary artery lesions caused by Kawasaki disease occurred, even in lesions without any apparent coronary artery aneurysms. In our study, we show safe and efficacious placement of second-generation stent without adverse effects during the short-term follow-up, but long-term follow-up is needed to determine the efficacy and complication.

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Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Cited by 5 publications

References 38 publications

Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease

Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease

Case Report: Interventional therapy for coronary artery occlusion in a 6-year-old child with Kawasaki disease

Characteristics and outcomes of patients with stent implantation for coronary artery lesions caused by Kawasaki disease – insights from second-generation stent implantation

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