Background:
Coronary artery aneurysms (CAA) are a serious complication of Kawasaki disease (KD). Coronary imaging usually describes aneurysms, stenosis and dilatation. Optical coherence tomography (OCT) is a technique useful for intracoronary imaging and coronary wall structure characterization.
Method:
KD patients scheduled for routine coronary angiography underwent OCT imaging between June 2013 and August 2014. Subjects’ clinical courses with echocardiography and angiography were reviewed to contrast with OCT findings.
Results:
OCT was performed on 18 patients 9.0 ± 5.1 years after KD at 12.4 ± 5.5 yo (range 3.5-21 yo). Of those, 14 (77.7%) had a history of CAA (7 giant CAA, 7 regressed CAA at time of OCT). Prophylactic intracoronary nitroglycerin was given (88.4 ± 45.5 μg/m2). Total X-ray exposure was 10.9 mGy/kg. One patient had a transitory uneventful vasospasm at the site of a former CAA, otherwise no major complications occurred (such as dissection, thrombosis, ischemia, arrhythmia). OCT findings were intimal hyperplasia in 15/18 (83.3%) on aneurysmal and regressed aneurysm segments. Intimal hyperplasia measured 390.8 ± 166.0 μm for the affected segments, compared to 61.7 ± 17.0 μm for the unaffected segments (p<0.001). Destroyed media, fibrosis, calcifications, macrophage infiltration, neovascularization and white thrombus were also seen (Table 1). In two cases with previously implanted stent, the neo-intima was identified, measuring 80-160 μm.
Conclusion:
In our experience, OCT proved safe and insightful in the setting of KD. The observed coronary structural changes correspond to histological findings described in the literature late after KD.
REGRESSED CORONARY ANEURYSM AFTER KAWASAKI DISEASE: AN OPTICAL COHERENCE TOMOGRAPHY (OCT) STUDY FROM A SINGLE INSTITUTION
