Interventions in Coronary Lesions Associated with Kawasaki Disease

Park, Jae Hyeong; Lee, Jae Hwan

Abstract

The incidence of coronary artery disease requiring coronary intervention in patients with Kawasaki disease is high. Because coronary artery lesions in Kawasaki disease commonly involve severe calcification and aneurysmal changes which can progress with time, in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly applied. However, the experience of coronary intervention in Kawasaki disease is extremely limited compared to that with intervention in adults, which provides satisfactory therapeutic results. There are several kinds of percutaneous coronary intervention techniques in Kawasaki disease including balloon angioplasty, stent implantation, rotational ablation, and directional coronary atherectomy. Satisfactory acute results for coronary balloon angioplasty can be obtained in patients in a relatively short interval from the onset of disease, especially within 6 years. However, the incidence of restenosis after angioplasty is still high. Stent implantation acquires larger luminal area, less restenosis rate and less aneurysmal formation than balloon angioplasty. Rotational ablation is a good interventional option with high success rate for longstanding Kawasaki disease with severe calcification. Intravascular ultrasound imaging provides valuable information for the selection of the appropriate interventional procedure and the assessment of postprocedural outcomes. To obtain good result and optimal decision making, cooperation between pediatric and adult cardiologists is essential. Postprocedural anticoagulation or antiplatelet regimens are required for proper long-term management.