ACUTE CORONARY SYNDROME: ANEURYSM THROMBOSIS IN KAWASAKI DISEASE

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Cardiology in the Young ◽

10.1017/s104795112000133x ◽

2020 ◽

Vol 30 (7) ◽

pp. 911-918

Author(s):

Etsuko Tsuda

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Kawasaki Disease ◽

Adverse Effects ◽

Stent Implantation ◽

Long Term Results ◽

Coronary Artery Lesions ◽

Coronary Syndrome ◽

Coronary Stent Implantation

AbstractFifty years have passed since the first report of Kawasaki disease in 1967, and the prevalence of acute coronary syndrome in Kawasaki disease patients with coronary artery lesions exceeding 40 years old has increased. Primary coronary stent implantation is currently an acceptable method in ischaemic coronary heart disease in adults. However, it is unknown whether the stent implantation is effective or not in this population. As the clue to answer this question, I reviewed the references on Kawasaki disease patients who underwent the stent implantations between 1997 and 2019. Thirty-three patients underwent stent implantations for 34 coronary arteries. Adverse effects in the late period were found in 19 (68%) of 28 vessels with follow-up angiograms. There were complete occlusion 9, restenosis 8, and migration 2. A new aneurysm formation was found in 7 (37%) among the 19 vessels, and 6 (86%) of the 7 vessels were drug-eluting stent and 5 were found after the procedure for chronic total occlusion. The adverse effects free-rate at 1 year and 3 years were 57 and 25%, respectively. At present, the usefulness of stent implantation in the long-term results was scarce. Even if primary percutaneous coronary intervention without a stent implantation is performed for acute coronary syndrome, it can be expected to maintain the patency of the culprit lesion for several years. It is better to avoid a stent implantation as long as possible in this population. Knowing the long-term efficacy and complications of stent implantations is important for deciding the procedure.

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Functional and Structural Alterations of Coronary Arteries Late After Kawasaki Disease and the Risk of Acute Coronary Syndrome in Adults

Kawasaki Disease ◽

10.1007/978-4-431-56039-5_44 ◽

2016 ◽

pp. 421-425 ◽

Cited By ~ 1

Author(s):

Yoshihide Mitani

Keyword(s):

Acute Coronary Syndrome ◽

Kawasaki Disease ◽

Coronary Arteries ◽

Structural Alterations ◽

Coronary Syndrome

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Two Young Adults Who Had Acute Coronary Syndrome after Regression of Coronary Aneurysms Caused by Kawasaki Disease in Infancy

Pediatric Cardiology ◽

10.1007/s00246-005-1233-8 ◽

2006 ◽

Vol 27 (3) ◽

pp. 372-375 ◽

Cited By ~ 23

Author(s):

E. Tsuda ◽

A. Hanatani ◽

K. Kurosaki ◽

H. Naito ◽

S. Echigo

Keyword(s):

Acute Coronary Syndrome ◽

Young Adults ◽

Kawasaki Disease ◽

Coronary Syndrome ◽

Coronary Aneurysms

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Acute coronary syndrome in adult patients with coronary artery lesions caused by Kawasaki disease: review of case reports

Cardiology in the Young ◽

10.1017/s1047951110001502 ◽

2010 ◽

Vol 21 (1) ◽

pp. 74-82 ◽

Cited By ~ 41

Author(s):

Etsuko Tsuda ◽

Tadaaki Abe ◽

Wataru Tamaki

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Kawasaki Disease ◽

Artery Bypass ◽

Adult Life ◽

Bypass Grafting ◽

Coronary Artery Lesions ◽

Giant Aneurysms ◽

Coronary Syndrome

AbstractInformation about acute coronary syndrome caused by Kawasaki disease-related coronary artery lesions in adults is sketchy. We reviewed the clinical features of 50 adult patients who had an acute coronary syndrome caused by coronary artery lesions due to Kawasaki disease or probable Kawasaki disease from 1980 to 2008. Of the 50 patients, 43 (90%) were male and seven were female (10%). Their ages at the onset of acute coronary syndrome ranged from 18 to 69 years, with a median of 28 years. The culprit lesion in 43 patients was thrombotic occlusion of an aneurysm, and 40 patients had giant aneurysms. In the three patients in whom no aneurysms were seen in coronary angiograms performed at the time of acute myocardial infarction, either giant aneurysms or aneurysms had been visualised in childhood. The initial treatment of acute coronary syndrome was as follows: intracoronary thrombolysis, 11; primary percutaneous coronary intervention, 9; emergency coronary artery bypass grafting, 3; and medication, 26. Elective coronary artery bypass grafting was performed in 15 patients. Three patients (6%) died. Of the 27 patients with additional coronary risk factors, 20 were smokers. Giant aneurysms due to Kawasaki disease continued to cause acute coronary syndrome in adult life with onset at a younger age than typifies that due to atherosclerosis in the general population, especially in male population rather than female population. Even when giant aneurysms regressed after the acute phase, a few patients still developed acute coronary syndrome in adult life. Smoking appears to be the most prominent additional risk factor.

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