Application of Percutaneous Transluminal Coronary Angioplasty to Coronary Arterial Stenosis in Kawasaki Disease

Ino, Toshihiro; Akimoto, Katsumi; Ohkubo, Mataichi; Nishimoto, Kei; Yabuta, Keijiro; Takaya, Junji; Yamaguchi, Hiroshi

doi:10.1161/01.cir.93.9.1709

Cited by 96 publications

(53 citation statements)

References 12 publications

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“…Previous studies have demonstrated that PBA is effective for patients within 6 years of the onset of KD, but at Ͼ6 years after onset, it is less effective. 5,8,15 In the present study, PBA successfully resolved stenotic lesions in 3 patients for whom the time since onset of KD had been Ͻ4 years. There have been a few reports in which stent implantation, a technique of coronary intervention commonly performed in adult patients, was applied to KD patients.…”

Section: Discussion Comparison With Previous Studiessupporting

confidence: 56%

“…[5][6][7][8][9][15][16][17] It is well known that PBA alone is less effective for long-term lesions with severe calcification. [5][6][7][8][9] Half of all coronary artery stenotic lesions, however, occur within 2 years of KD onset. 1 In these cases, the stenotic lesions are caused primarily by intimal hypertrophy without calcification.…”

Section: Selection Of An Appropriate Device For Catheter Interventionmentioning

confidence: 99%

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Sequential Follow-Up Results of Catheter Intervention for Coronary Artery Lesions After Kawasaki Disease

et al. 2002

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Background-The purpose of this study was to assess the sequential follow-up results of catheter intervention in Kawasaki disease by use of quantitative coronary angiography (QCA) and intravascular ultrasound imaging. Methods and Results-Catheter intervention was performed on 23 stenotic lesions in 22 patients (aged 2 to 24 years).Percutaneous balloon angioplasty (PBA) was performed in 4 patients, stent implantation in 7, percutaneous transluminal coronary rotational ablation (PTCRA) in 10, and a combination of PTCRA with stent implantation in 2. A total of 21 lesions (91%) were successfully dilated by catheter intervention without major or minor complications. One patient immediately underwent coronary artery bypass grafting (CABG) surgery because stent implantation failed to resolve his lesion. At 4 to 6 months after catheter intervention, 2 restenotic lesions (9%) were detected by QCA in 2 patients who had undergone PBA, and these patients subsequently underwent CABG surgery. In 6 months to 3 years after catheter intervention, no patients showed evidence of ischemic findings. At 3 to 4 years after catheter intervention, QCA and intravascular ultrasound studies were performed on 15 lesions in 14 patients. Two restenotic lesions (13%) were detected by QCA in 2 patients. One of the 2 had stent implantation and underwent CABG surgery, and the other had undergone PTCRA and underwent re-PTCRA. Thirteen patients demonstrated no ischemic findings at 3 to 8 years after catheter intervention. Conclusion-Catheter intervention for Kawasaki disease can be accomplished and can be effective in the short term, but the long-term efficacy should be verified by further study. (Circulation. 2002;105:3004-3010.)

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Section: Discussion Comparison With Previous Studiessupporting

confidence: 56%

Section: Selection Of An Appropriate Device For Catheter Interventionmentioning

confidence: 99%

Sequential Follow-Up Results of Catheter Intervention for Coronary Artery Lesions After Kawasaki Disease

et al. 2002

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“…13) A previous study has found that balloon angioplasty is not an effective means of revascularization in patients with coronary arterial stenosis due to KD because the lesions are stiff and often associated with calcification. 14,15) Moreover, as in our case 2, coronary aneurysms newly develop at sites of balloon dilatation in some patients. 16) Stent implantation is also not always useful for the treatment of the coronary stenotic lesions of KD because it is often difficult to deliver the stent into the severe stenotic and stiff lesions that have developed over a long period as a sequela of KD.…”

Section: Discussionsupporting

confidence: 63%

Interventional Treatment for Very Young Adults With Acute Myocardial Infarction: Clinical Manifestations and Outcome

Shiraishi¹,

Shiraishi²,

Hayashi

et al. 2005

Int. Heart J.

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SUMMARYDirect percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is now established as a standard therapy for older patients. However, experience with PCI in very young adults with AMI has been limited. In this report we retrospectively evaluated the effectiveness of PCI for very young adults with AMI and estimated their clinical characteristics and outcome. Of the 502 patients with AMI, 5 were 35 years old or younger (1.0%) during a period of 4 years (2000)(2001)(2002)(2003)(2004). We assessed the utility of PCI in these five consecutive patients under the age of 35 presenting with a first AMI. Five AMI patients, ranging in age from 20 to 34 years (median, 27 ± 5 years) underwent direct PCI for the culprit lesions. The lesions targeted for PCI were located in the left anterior descending artery in 3 patients and in the right coronary artery in 2 patients. One patient had a past history of Kawasaki disease (KD). In all of the patients, PCI were angiographically effective at the acute phase without complication. In hospital course, a subacute stent thrombosis occurred in one patient. Follow-up angiograms performed 6 months after the procedure revealed no restenosis, but identified a new coronary aneurysm in one patient with a past history of KD and a regressed giant coronary aneurysm probably due to atypical KD in another patient, which were confirmed by intravascular ultrasound. There was one death ascribed to heart failure 8 months after the initial PCI. The findings of this report suggest that PCI for very young adults with AMI can be safe and effective in the short-term. (Int Heart J 2005; 46: 1-12) Key words: Percutaneous coronary intervention, Kawasaki disease, Coronary aneurysm, Intravascular ultrasound ACUTE myocardial infarction (AMI) is rare in young adults. Previous studies have estimated that young patients less than 45 years old make up between 2% and 10% of all AMIs.1) The etiology of their AMI varies but is usually not due toFrom the

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“…In general, balloon angioplasty has not been successful even with high-pressure balloons when it is done Ͼ2 years after the acute illness because of dense fibrosis and calcification in the arterial wall. 207,208 The relatively high balloon pressures that are necessary under these circumstances can lead to late neoaneurysm formation. 208 For this reason, if percutaneous transluminal coronary angioplasty cannot be performed with a balloon pressure of Ͻ10 atm, then rotational ablation or bypass surgery is advisable as an alternative procedure.…”

Section: Interventional Cardiac Catheterization Techniquesmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,578

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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Application of Percutaneous Transluminal Coronary Angioplasty to Coronary Arterial Stenosis in Kawasaki Disease

Cited by 96 publications

References 12 publications

Sequential Follow-Up Results of Catheter Intervention for Coronary Artery Lesions After Kawasaki Disease

Sequential Follow-Up Results of Catheter Intervention for Coronary Artery Lesions After Kawasaki Disease

Interventional Treatment for Very Young Adults With Acute Myocardial Infarction: Clinical Manifestations and Outcome

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

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