Intracoronary Urokinase in Kawasaki Disease: Treatment and Prevention of Myocardial Infarction

Abstract

The main cause of death in Kawasaki disease is myocardial infarction due to thrombotic occlusion of a coronary aneurysm. Intracoronary thrombolytic treatment was performed in 15 patients with Kawasaki disease with giant coronary aneurysms. Three patients had acute myocardial infarction, four demonstrated silent myocardial infarction, three suffered chest pain and five did not show ischemia features but had massive thrombus in the coronary aneurysms. Urokinase was infused into the coronary aneurysms as a bolus of 8,000 to 10,000 units/kg via a catheter over 10 minutes. Partial but significant coronary recanalization was achieved after injection of urokinase in a patient with acute myocardial infarction. Complete resolution of massive intracoronary thrombi was observed in 3 of 15 patients, and partial resolution was recognized in 4 cases. In 7 patients, the size of thrombus did not change. Recurrence of the thrombus was observed in 4 patients by serial two‐dimensional echocardiography. Urokinase was readmmistered and two showed significant reduction in the thrombus. All patients have been followed for more than 2 years with longest 8 years (mean: 3.3 yrs), and none have had a recurrence of myocardial infarction or died. These findings suggest that intracoronary urokinase is useful for the treatment and prevention of myocardial infarction in Kawasaki disease.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

“…In case reports, streptokinase, 184,185 urokinase, [186][187][188] and tissue plasminogen activator (tPA) 189,190 each has been administered to infants and children with coronary thrombosis with varying success rates (evidence level C). Because no randomized, controlled trials have been performed in children, the treatment of infants and children with coronary thrombosis is derived from studies in adults with acute coronary syndromes.…”

Successful intravenous streptokinase treatment of a child with Kawasaki disease complicated by acute myocardial infarction

“…According to Kato's report [4], the recurrent MI carries very high mortality rate. Therefore, the most effective way to prevent recurrent MI in Kawasaki disease is reduction thrombus size by early thrombolytic therapy [3]. The coronary artery bypass is another treatment of choice.…”

Interventional Treatment for Very Young Adults With Acute Myocardial Infarction: Clinical Manifestations and Outcome

“…12) Percutaneous transluminal coronary recanalization and intravenous coronary thrombolysis have been used to treat AMI in patients with KD. 13) A previous study has found that balloon angioplasty is not an effective means of revascularization in patients with coronary arterial stenosis due to KD because the lesions are stiff and often associated with calcification. 14,15) Moreover, as in our case 2, coronary aneurysms newly develop at sites of balloon dilatation in some patients.…”