Coronary sequelae of Kawasaki disease treated with rotational atherectomy and drug coated balloon

Abstract

Introduction: Kawasaki disease (KD) is an acute vasculitis syndrome that mainly affects children and is the first cause of acquired heart disease. Coronary artery lesion is the most serious complication of KD. Only two previous studies have reported similar cases, but we reported patient was younger and had a longer follow-up. Patient concerns: We reported a case of coronary sequelae of KD treated with rotational atherectomy and drug coated balloon (DCB). During the week after surgery, the patient complained of a slight chest pain intermittently, but no longer appeared after that. Diagnosis: We diagnosed by electrocardiogram and angiography. Angiography showed that the anterior descending branch (LAD) proximal stenosis was 95%, the right coronary artery (RCA) middle stenosis was 99%, and the calcification was severe. Interventions: We treat the patient with rotational atherectomy using a 1.25 mm burr, pre-dilatation of the stenosis lesion with a 3.5 mm × 15 mm non-compliant balloon was achieved. Then 3.5 mm × 15 mm drug eluting balloon was inflated at 10 atm for 60 seconds. Outcomes: After the 6-month follow-up (from October 2018 to March 2019), the symptom of angina disappeared. Coronary angiography 6 months later showed no apparent progression of vessel narrowing. Conclusion: The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis.

Drug-Coated Balloon Treatment for Possible Sequelae of Kawasaki Disease Evaluated by Multi-Modalities

“…4) However, to date, only few case reports have described the use of DCB in KD patients with short-term follow-up, mostly in middleaged patients with significant calcified lesions that required rotational atherectomy. 5,6) The present case indicated that DCB therapy may achieve promising outcomes for adolescent KD patients in the 1-year clinical and imaging follow-up, although the long-term efficacy and safety of the "leave nothing behind" strategy still need further validation.…”

“…4) However, reports of DCB use for KD patients are still limited, especially for younger patients. 5,6) Here, we present the case of an 18-year-old female undergoing successful PCI for possible sequelae of KD with multimodality-guided DCB treatment.…”

Drug-coated balloon angioplasty for coronary stenotic lesions in a paediatric patient after Kawasaki disease

“…4 There are only a few case reports on use of drug-coated balloon for treating coronary sequelae of Kawasaki disease in adults, two cases were combined with rotational atherectomy by Shiraishi and Shi, respectively, another was combined with laser excimer angioplasty and cutting balloon by Kawamura. [5][6][7] They all showed good results, and rotational atherectomy followed by drug-coated balloon dilation might contribute to deferring repeat intervention. 5 To our knowledge, our case is the first to describe successful percutaneous revascularisation using drug-coated balloon for coronary sequelae of Kawasaki disease in paediatric.…”

Unusual interventional treatment of a complex calcified coronary artery lesion in a child with Kawasaki disease: a case report

“…Angioplasty of these lesions is often complex, whatever the technique used, and is exposed to immediate complications (coronary rupture, cardiac tamponade, death) or delayed complications (false aneurysms, restenosis or thrombosis related to under-expansion and/or malapposition). 7 Detailed evaluation of the severity of calcifications is important to adapt to the right therapeutic strategy before stenting. 6 These structural characteristic details are revealed and quantified only by using intravascular imaging.…”