Pathological Study of Postcoronary Arteritis in Adolescents and Young Adults: With Reference to the Relationship Between Sequelae of Kawasaki Disease and Atherosclerosis

Abstract

To clarify whether the cardiac sequelae of Kawasaki disease (KD), postcoronary arteritis lesions can become a risk factor for atherosclerosis of the coronary arteries, six autopsy cases of patients older than 15 years of age with coronary arterial lesions caused by arteritis in childhood were examined histologically. Twenty-four arteries were inspected: 10 had no evidence of aneurysm formation, 7 arteries manifested simple dilatation of the lumen, and in 7 arteries there were aneurysms with recanalization. In the group in which there were no aneurysms, "new intimal thickening" was observed in addition to the preexisting intimal thickening which had been caused by arteritis in the acute phase of KD. In the second group with aneurysmal arteries whose lumen remained dilated, thrombotic occlusion occurred in 4 of 6 aneurysms. In addition, advanced atherosclerotic changes (i.e., complicated lesions) were found in a 39-year-old patient. Finally, in the third group of arteries which manifested recanalized lumens after thrombotic occlusion of the aneurysms, new intimal thickening was seen on the internal side and some of them were occluded. The findings in this study suggest that aneurysms present in coronary arteries in individuals with a history of KD constitute a risk factor for atherosclerosis later in life.

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

“…[4][5][6] The mechanism responsible for this finding is unclear, however, differences in tissue composition of vessel walls might play a role. Thickened intima in KD coronary sequelae is generally composed of fibrous tissue with lower cell density, inconsistent with adult atherosclerotic plaque, 1) implying lower proliferative properties of intima in KD sequelae in response to PCI-related vessel injury. In the present case, however, during the first PCI, OFDI delineated fibrofatty plaque at the culprit site, indicating the presence of early atherosclerotic change in KD sequelae.…”

“…[1][2][3] Since these stiff calcified lesions have risk of stent underexpansion and neo-aneurysmal formation ascribed to high-pressure balloon inflation, rotational atherectomy with/without additional low-pressure balloon dilation alone has been a mainstay of interventional treatment for stenosis due to the coronary sequelae of KD. [4][5][6] In contrast, drug-coated balloons (DCB) now play a central role in the treatment of in-stent restenosis through their inhibition of neointimal hyperplasia, despite the lack of evidence for de novo coronary artery disease.…”

Premature Atherosclerosis Long After Kawasaki Disease

“…Likewise, no atheromatous plaques were found in seemingly normal coronary arteries distal to aneurysmsin 10 autopsied adults KD patients (Burns et al, 1996). On the contrary, Takahashi et al reported that 3 patients who were 15, 20, and 39 years of age had new intimal thickening, including atheroma-like bright areas and foamy macrophages in CALs (Takahashi et al, 2001). Also, Negoro et al showed that a substantial lipid core with cholesterol crystals and macrophages was found in an atherectomy specimen from a stenotic lesion in a 32-year-old man who presented with acute coronary syndrome (Negoro et al, 2003).…”

“…Even in coronary arteries in which there is no aneurysm formation in the acute phase, mild intimal thickening may be seen in some patients (Takahashi et al,2001). Therefore, there is some debate about the possibility that a history of KD might be a risk factor in the progression of atherosclerosis.…”

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2013)

“…Recanalized lumens may become stenotic due to the proliferation of cellular fibrous tissues, and active remodeling is present at the site of aneurysms even during the remote phase. 39,42 c. Coronary Arteries Without Aneurysm Formation Autopsy of patients with a history of Kawasaki disease who died from causes other than the disease has revealed diverse findings in arteries including clear scars of healed arteritis 43 and no scars. 44 There is no medical consensus about long-term prognosis of coronary artery lesions due to Kawasaki disease.…”