Korean Circ J.  2011 Feb;41(2):53-57. 10.4070/kcj.2011.41.2.53.

Catheter Interventions for Kawasaki Disease: Current Concepts and Future Directions

• Akagi T

• KMID: 2225135
• DOI: http://doi.org/10.4070/kcj.2011.41.2.53

Abstract

During the past 15 years, clinical experience with catheter interventional treatment in patients with Kawasaki disease, including balloon angioplasty, stent implantation, rotational ablation, and transluminal coronary revascularization, has been gradually increasing. Because the coronary artery lesions in Kawasaki disease involve severe calcifications, the indications or catheter intervention techniques have not been established for adult patients with Kawasaki disease. Satisfactory acute results for coronary balloon angioplasty have been obtained in patients with a relatively short interval from the onset of disease, especially within 6 years; however, the incidence of restenosis after angioplasty is still high. Rotational ablation may be the most appropriate catheter intervention technique for patients with Kawasaki disease. The advantage of rotational ablation is the high success rate, even in patients with calcified coronary artery stenosis. Stent implantation requires larger arterial access and is not possible in younger children. Care should be paid to the detection of newly-formed aneurysms, as the formation of new aneurysms is associated with the use of additional balloon angioplasty using high pressure balloon inflation. Anticoagulation or anti-platelet regimens are essential for long-term management. Coronary intervention in Kawasaki disease requires special techniques and knowledge of cardiovascular involvement. The procedure should be managed under the close collaboration between pediatric cardiologists and coronary interventional cardiologists.

Keyword

Kawasaki disease; Angioplasty balloon; Coronary arteries

MeSH Terms

Adult
Aneurysm
Angioplasty
Angioplasty, Balloon
Angioplasty, Balloon, Coronary
Catheters
Child
Cooperative Behavior
Coronary Stenosis
Coronary Vessels
Humans
Imidazoles
Incidence
Inflation, Economic
Mucocutaneous Lymph Node Syndrome
Nitro Compounds
Stents
Imidazoles
Nitro Compounds

Figure

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  Fig. 1 Event free survival of various interventions.

Reference

1. Akagi T, Ogawa S, Ino T, et al. Catheter interventional treatment in Kawasaki disease: a report from the Japanese pediatric interventional cardiology investigation group. J Pediatr. 2000. 137:181–186.

2. Ino T, Akimoto K, Ohkubo M, et al. Application of percutaneous transluminal coronary angioplasty to coronary arterial stenosis in Kawasaki disease. Circulation. 1996. 93:1709–1715.

3. Ogawa S, Fukazawa R, Ohkubo T, et al. Silent myocardial ischemia in Kawasaki disease: evaluation of percutaneous transluminal coronary angioplasty by dobutamine stress testing. Circulation. 1997. 96:3384–3389.

4. Hijazi ZM, Smith JJ, Fulton DR. Stent implantation for coronary artery stenosis after Kawasaki disease. J Invasive Cardiol. 1997. 9:534–536.

5. Hashmi A, Lazzam C, McCrindle BW, Benson LN. Stenting of coronary artery stenosis in Kawasaki disease. Catheter Cardiovasc Interv. 1999. 46:333–336.

6. Sugimura T, Yokoi H, Sato N, et al. Interventional treatment for children with severe coronary artery stenosis with calcification after long-term Kawasaki disease. Circulation. 1997. 96:3928–3933.

7. Ishii M, Ueno T, Ikeda H, et al. Sequential follow-up results of catheter intervention for coronary artery lesions after Kawasaki disease: quantitative coronary artery angiography and intravascular ultrasound imaging study. Circulation. 2002. 105:3004–3010.

8. Kato H, Inoue O, Ichinose E, Akagi T, Sato N. Intracoronary urokinase in Kawasaki disease: treatment and prevention of myocardial infarction. Acta Paediatr Jpn. 1991. 33:27–35.

9. Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation. 1996. 94:1379–1385.

10. Suzuki A, Miyagawa-Tomita S, Komatsu K, et al. Active remodeling of the coronary arterial lesions in the late phase of Kawasaki disease: immunohistochemical study. Circulation. 2000. 101:2935–2941.

11. Kato H, Ishii M, Akagi T, et al. Interventional catheterization in Kawasaki disease. J Interv Cardiol. 1998. 11:355–361.

12. Yoshikawa Y, Yagihara T, Kameda Y, et al. Result of surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease. Eur J Cardiothorac Surg. 2000. 17:515–519.

13. Kitamura S, Kameda Y, Seki T, et al. Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease: a multicenter cooperative study. J Thorac Cardiovasc Surg. 1994. 107:663–673.

14. Ishii M, Ueno T, Akagi T, et al. Guidelines for catheter intervention in coronary artery lesion in Kawasaki disease. Pediatr Int. 2001. 43:558–562.

15. Sugimura T, Kato H, Inoue O, et al. Intravascular ultrasound of coronary arteries in children: assessment of the wall morphology and the lumen after Kawasaki disease. Circulation. 1994. 89:258–265.

16. Kato H, Inoue O, Kawasaki T, Fujiwara H, Watanabe T, Toshima H. Adult coronary artery disease probably due to childhood Kawasaki disease. Lancet. 1992. 340:1127–1129.

17. Iemura M, Ishii M, Sugimura T, Akagi T, Kato H. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart. 2000. 83:307–311.

18. Yamakawa R, Ishii M, Sugimura T, et al. Coronary endothelial dysfunction after Kawasaki disease: evaluation by intracoronary injection of acetylcholine. J Am Coll Cardiol. 1998. 31:1074–1080.

19. Ogawa S, Ohkubo T, Fukazawa R, et al. Estimation of myocardial hemodynamics before and after intervention in children with Kawasaki disease. J Am Coll Cardiol. 2004. 43:653–661.

20. Tsuda E, Abe T, Tamaki W. Acute coronary syndrome in adult patients with coronary artery lesions caused by Kawasaki disease: review of case reports. Cardiol Young. 2011. 21:74–82.

21. Muta H, Ishii M. Percutaneous coronary intervention versus coronary artery bypass grafting for stenotic lesions after Kawasaki disease. J Pediatr. 2010. 157:120–126.

22. Kitamura S, Tsuda E, Kobayashi J, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation. 2009. 120:60–68.

23. Akagi T. Interventions in Kawasaki disease. Pediatr Cardiol. 2005. 26:206–212.