Kawasaki Related Coronary Artery Disease Refractory to Angioplasty: The Role of Intravascular Shockwave Lithotripsy

Area of Science:

• Cardiology
• Pediatric Rheumatology
• Interventional Cardiology

Background:

• Kawasaki disease is a leading cause of acquired heart disease in children, often leading to coronary artery aneurysms (CAAs).
• CAAs in Kawasaki disease survivors pose a significant risk for cardiovascular complications and necessitate complex management strategies.
• Heavily calcified coronary lesions present a therapeutic challenge, particularly in patients with a history of Kawasaki disease.

Observation:

• A 27-year-old patient with a history of Kawasaki disease at age two presented with severe, calcified coronary artery stenosis and CAAs.
• Conventional interventional techniques including cutting balloons, orbital atherectomy, and rotational atherectomy were ineffective in treating the calcified stenosis.
• The patient had undergone appropriate treatment for Kawasaki disease in childhood.

Findings:

• Intravascular lithotripsy (IVL) was utilized to treat the heavily calcified coronary stenosis, achieving successful lesion preparation.
• Following IVL, the patient was treated with a drug-eluting stent and a covered stent to exclude the coronary artery aneurysm.
• A good final angiographic and procedural result was achieved after the combined intervention.

Implications:

• Intravascular lithotripsy represents a promising therapeutic option for managing severely calcified coronary lesions in patients with Kawasaki disease-associated CAAs.
• This case highlights the potential of IVL to overcome limitations of traditional atherectomy devices in complex coronary anatomies.
• Successful management with IVL and stenting may improve long-term cardiovascular outcomes for patients with Kawasaki disease-related coronary complications.