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Interventional treatment for children with severe coronary artery stenosis with calcification after long-term
1Department of Pediatrics, Kurume University School of Medicine, Kokura Memorial Hospital, Japan.
Insights
Percutaneous transluminal coronary rotational ablation (PTCRA) effectively treated severe, calcified coronary artery stenosis in children following Kawasaki disease (KD). This innovative approach successfully reduced stenosis, offering a viable treatment option for long-term KD complications.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Kawasaki disease (KD) can lead to long-term ischemic heart disease in approximately 4% of affected children.
- Calcified coronary artery stenosis is a common and challenging complication following KD.
- Assessing novel interventions for managing KD sequelae is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous transluminal coronary rotational ablation (PTCRA) in treating severe coronary artery stenosis in children with a history of KD.
- To determine the utility of intravascular ultrasound imaging in assessing coronary artery pathology and guiding treatment decisions in this patient population.
Main Methods:
- Four pediatric patients (12-13 years old) with significant coronary artery stenosis post-KD underwent percutaneous transluminal coronary angioplasty (PTCA) and PTCRA.
- Intravascular ultrasound imaging was employed to assess coronary artery wall morphology.
- PTCA was attempted first, followed by PTCRA if PTCA was unsuccessful due to severe stenosis and calcification.
Main Results:
- PTCA failed in three out of four patients due to severe stenosis and calcification.
- PTCRA was successful in reducing stenosis from 90% to 25% in the affected arteries.
- Follow-up angiography at 4 months showed no restenosis, although two patients developed mild aneurysms.
Conclusions:
- PTCRA is a valuable technique for revascularizing coronary arteries with severe, calcified stenosis resulting from long-term Kawasaki disease complications.
- Intravascular ultrasound imaging plays a key role in evaluating coronary artery wall pathology and selecting appropriate interventional strategies.
- PTCRA offers a promising therapeutic option for managing complex coronary artery lesions in pediatric patients with a history of KD.
Background:
About 4% of children with Kawasaki disease (KD) eventually develop ischemic heart disease, which is often associated with calcified stenosis. We assessed the utility of the percutaneous transluminal coronary rotational ablation (PTCRA) in children with coronary artery stenosis after KD.
Methods And Results:
Four children (three boys and one girl; age, 12 to 13 years) with coronary artery stenosis underwent percutaneous transluminal coronary angioplasty (PTCA) and PTCRA 11.8+/-0.9 years after the onset of KD. Morphology of the coronary artery wall was evaluated by intravascular ultrasound imaging. In one patient, the targeted lesion for intervention was in the left anterior descending artery (90% stenosis); in the other three patients, it was in the middle of the right coronary artery (75% to 90% stenosis). PTCA failed in three patients because of severe stenosis with calcification. However, PTCRA proved effective, with stenosis rates reduced from 90% to 25%. Follow-up coronary angiography performed 4 months after the procedure demonstrated no restenosis, but mild aneurysms occurred in two patients.
Conclusions:
This study suggests that PTCRA is useful for revascularizing coronary arteries with severe stenosis and calcification as long-term sequelae of KD. Intravascular ultrasound imaging is useful in assessing the coronary artery wall pathology and in selecting the best treatment intervention.