Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report

Abstract

We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.

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

“…Primary stenting in patients with acute coronary syndrome after Kawasaki disease was performed in eight patients between 1997 and 2019 (Table 1). [4][5][6][7][8][9][10] There were six males and two females. The age at the time of the stenting ranged from 19 to 35 years, with a median of 24 years.…”

“…A 22-year-old man suffered from acute myocardial infarction due to a severe calcified aneurysm at the bifurcation of the left coronary artery and underwent an emergency stent implantation with a polyurethane-covered stent (PK papyrus Biotronik) for the left main lesion. 4 He had experienced cardiogenic shock 13 months after stent implantation because of a complete occlusion with a malposition, although dual anti-platelet therapy was performed after the procedure. He had an emergency coronary artery bypass grafting 24 hours after the re-percutaneous transluminal coronary intervention for the left main complete occlusion.…”

“…One patient in the above primary stenting in acute coronary syndrome was included. 4 The age at the procedure ranged from to 25 years. Three covered stents were occluded.…”

Die Geheimnisse rund um die Kawasaki-Krankheit: Eine Literaturübersicht

“…Häufigkeit dieser Pathologie bei nicht-asiatischen Populationen, die nicht von Asiaten abstammen, besagt (SCARDINA et al, 2007). In Bezug auf die mit DK assoziierte Sterblichkeitsrate ist sie sehr niedrig, da sie unter 0,1% liegt (BARCA et al, 2019).…”

Comment on Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report

“…As Barca et al [4] wonderfully presented in their report, outcomes of coronary techniques originally approved for vessels with atherosclerotic disease in this special population with underlying vasculitis remain as a question to be answered. Their report is significant in demonstrating unfavourable long-term outcomes related with an initially successful implantation of a PTFE-covered stent as well as management of the stent-thrombosis with surgical ligation of protected left main coronary artery (LMCA) ostium as a means of protecting the vessel from future thrombotic events and competition.…”