“Arteries Within the Artery” After Kawasaki Disease

Terashima, Mitsuyasu; Awano, Kojiro; Honda, Yasuhiro; Yoshino, Nagisa; Mori, Takao; Fujita, Hideki; Ohashi, Yoshitaka; Seguchi, Osamu; Kobayashi, Katsuya; Yamagishi, Masakazu; Fitzgerald, Peter J.; Yock, Paul G.; Maeda, Kazumi

doi:10.1161/01.cir.0000030708.86783.92

Cited by 36 publications

(12 citation statements)

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“…Thus, shrinkage of focal or ring-shaped calcifications as assessed by CA radiography actually indicates progression of the intraluminal thrombotic process. Thus, the phenomenon of “arteries within the artery” is a consequence of organization and recanalization of thrombi [39]. Echocardiography primarily images the proximal portion of the CA and may therefore underestimate the extent of distal CA vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

Three Linked Vasculopathic Processes Characterize Kawasaki Disease: A Light and Transmission Electron Microscopic Study

et al. 2012

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BackgroundKawasaki disease is recognized as the most common cause of acquired heart disease in children in the developed world. Clinical, epidemiologic, and pathologic evidence supports an infectious agent, likely entering through the lung. Pathologic studies proposing an acute coronary arteritis followed by healing fail to account for the complex vasculopathy and clinical course.Methodology/Principal FindingsSpecimens from 32 autopsies, 8 cardiac transplants, and an excised coronary aneurysm were studied by light (n=41) and transmission electron microscopy (n=7). Three characteristic vasculopathic processes were identified in coronary (CA) and non-coronary arteries: acute self-limited necrotizing arteritis (NA), subacute/chronic (SA/C) vasculitis, and luminal myofibroblastic proliferation (LMP). NA is a synchronous neutrophilic process of the endothelium, beginning and ending within the first two weeks of fever onset, and progressively destroying the wall into the adventitia causing saccular aneurysms, which can thrombose or rupture. SA/C vasculitis is an asynchronous process that can commence within the first two weeks onward, starting in the adventitia/perivascular tissue and variably inflaming/damaging the wall during progression to the lumen. Besides fusiform and saccular aneurysms that can thrombose, SA/C vasculitis likely causes the transition of medial and adventitial smooth muscle cells (SMC) into classic myofibroblasts, which combined with their matrix products and inflammation create progressive stenosing luminal lesions (SA/C-LMP). Remote LMP apparently results from circulating factors. Veins, pulmonary arteries, and aorta can develop subclinical SA/C vasculitis and SA/C-LMP, but not NA. The earliest death (day 10) had both CA SA/C vasculitis and SA/C-LMP, and an “eosinophilic-type” myocarditis.Conclusions/SignificanceNA is the only self-limiting process of the three, is responsible for the earliest morbidity/mortality, and is consistent with acute viral infection. SA/C vasculitis can begin as early as NA, but can occur/persist for months to years; LMP causes progressive arterial stenosis and thrombosis and is composed of unique SMC-derived pathologic myofibroblasts.

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Section: Discussionmentioning

confidence: 99%

Three Linked Vasculopathic Processes Characterize Kawasaki Disease: A Light and Transmission Electron Microscopic Study

et al. 2012

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“…Data from the literature show that the 62 SRCT lesions may be asymptomatic -20 cases (10-12, 20, 22, 26, 28) or symptomatic, associated with stable CAD -23 cases (2,10,13,17,20,21,24,25,(29)(30)(31)(32), UA -5 cases (2,18,27) or acute STEMI -12 cases (2,10,14-16). Other two cases had an undeclared clinical condition (3,23).…”

Section: Fourth Spontaneous Recanalization Of Coronary Thrombus (Srctmentioning

confidence: 95%

“…Besides the previous mentioned study (10), exhaustive search of the literature showed 23 case reports (3, and one study (2) on 6 other cases reported to date, totalizing 62 SRCT cases (Table IV), focusing mainly on the clinical presentation, angiographic and intravascular imaging aspect, treatment modality and very few comments related to the mechanism for thrombus formation. Also, there are scarce data on prognostic and follow up of the SRCT patients.…”

Section: Fourth Spontaneous Recanalization Of Coronary Thrombus (Srctmentioning

confidence: 99%

“…The diagnosis becomes possible only by intravascular imaging. The reported angiographic aspect was described as braided in 24 cases (10,16,25,30), as haziness in 18 cases (2, 3, 10, 11, 14, 15, 17, 19-22, 24, 27, 28, 31, 32), as pseudodissection in 15 cases (3,10,13,25) and as occlusions in 5 cases (10,12,18,23,29). Our study shows that only 14.3% of the CA suspected SRCT cases (4 out of 28) were truly OCT confirmed SRCT.…”

Section: Fourth Spontaneous Recanalization Of Coronary Thrombus (Srctmentioning

confidence: 99%

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Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

Spînu

Homorodean

Ober

et al. 2020

In Vivo

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Background/Aim: Spontaneous recanalization of coronary thrombus (SRCT) is a rare in vivo appearance, with a nonspecific angiographic aspect. The aim of this study was to investigate the importance of optical coherence tomography (OCT) use for SRCT identification, characterization of pathogenic mechanisms and optimal treatment. Patients and Methods: We retrospectively analyzed all patients with angiographic suspicion of SRCT who underwent coronary angiography for suspected coronary artery disease and afterward investigated by OCT imaging. Results: We identified 28 cases with angiographic suspicion of SCRT (0.41% of CA) and confirmed it in 4 patients (0.05% of CA). OCT provided insight about the underlying SRCT mechanism: possible complicated atherosclerotic plaques in two cases and, respectively, spontaneous coronary artery dissection in other two cases. OCT provided accurate lesion assessment and offered optimal PCI materials selection. Conclusion: Besides providing the diagnosis, OCT also improved characterization of SRCT pathogenic mechanisms, in the four confirmed SRCT cases, supporting the role of coronary wall in situ complications, namely dissection of an atherosclerotic plaque or spontaneous dissection of a normal coronary wall.

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“…"Arteries within the artery" lesion is relevant to recanalized thrombosis (2). We report an adult case of acute coronary syndrome associated with arteries within the artery lesion which was depicted by intravascular ultrasound (IVUS) (6) (Fig. 3B).…”

Section: "Arteries Within the Artery" Is A Histopathological Finding mentioning

confidence: 99%

Arteries within the Artery of Coronary Artery in an Adult Patient with Acute Coronary Syndrome

et al. 2010

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“Arteries Within the Artery” After Kawasaki Disease

Cited by 36 publications

References 0 publications

Three Linked Vasculopathic Processes Characterize Kawasaki Disease: A Light and Transmission Electron Microscopic Study

Three Linked Vasculopathic Processes Characterize Kawasaki Disease: A Light and Transmission Electron Microscopic Study

Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

Arteries within the Artery of Coronary Artery in an Adult Patient with Acute Coronary Syndrome

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