Rotational ablation and stent placement for severe calcific coronary artery stenosis after Kawasaki disease

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Kawasaki disease (KD) is a leading cause of acquired pediatric heart disease.
• Coronary artery aneurysms (CAAs) are a serious complication of KD, increasing the risk of stenosis and myocardial infarction.
• Management of severe KD-induced coronary stenosis in infants remains challenging.

Observation:

• A 5-year-old child presented with a history of giant coronary artery aneurysms diagnosed at 4 months of age following Kawasaki disease.
• Coronary angiography revealed severe calcific stenosis in the proximal left anterior descending artery.
• Initial balloon angioplasty was unsuccessful in resolving the obstruction.

Findings:

• Rotational atherectomy was performed to address the severe stenosis.
• Despite initial intervention, surveillance angiography at 6 months showed critical restenosis.
• Repeat rotational atherectomy followed by coronary stenting was successfully performed.

Implications:

• This case highlights the potential for advanced interventional techniques in managing complex coronary artery lesions in young children with a history of Kawasaki disease.
• Coronary stenting in such a young patient with KD-induced CAAs is unprecedented and expands the therapeutic options for this high-risk population.
• Further research is warranted to evaluate the long-term outcomes and safety of coronary stenting in pediatric patients with Kawasaki disease.