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Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease

Part of: Interventional Cardiology

Published online by Cambridge University Press:  04 June 2021

Etsuko Tsuda Open the ORCID record for Etsuko Tsuda [Opens in a new window] ,
Yasuhide Asaumi ,
Teruo Noguchi  and
Satoshi Yasuda
Etsuko Tsuda*
Affiliation:
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
Yasuhide Asaumi
Affiliation:
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
Teruo Noguchi
Affiliation:
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
Satoshi Yasuda
Affiliation:
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
*
Author for correspondence: Etsuko Tsuda, Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita-shi, Osaka, 564-8565, Japan. Tel: 81-6-6170-1070; Fax: 81-6-6170-1748. E-mail: etsuda@ncvc.go.jp
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Abstract

Thirteen boys and one girl, 5–30 years (median 13 years), underwent percutaneous transluminal coronary rotational atherectomy. The interval from the onset of Kawasaki disease to PTCRA ranged from 5 to 29 years (median 12 years). The follow-up period was 1–22 years (median 13 years). The target vessels were the right coronary artery (7), left anterior descending artery (3), left circumflex (2), and left main trunk (2). The maximum burr size used was 1.75 mm in four, 2.00 mm in four, and 2.15 mm in six. The immediate results of rotational atherectomy were successful in all patients, and the mean stenosis degree improved from 86 ± 15% (mean ± standard deviation) to 37 ± 14% (p < 0.001). Cardiac events in the late period were found in four patients (29%). Acute myocardial infarction occurred in two, and syncope and ventricular fibrillation in one each. The cardiac event-free rate at 10 and 20 years was 79% (95% confidence interval 50–92) and 39% (6–87), respectively, (n = 14). The overall 20-year patency rate was 54% (95% CI 28–78). That in patients more than 10 years old was 77% (95% CI 42–94, n = 10). PTCRA alone is suitable for severe localised stenosis with calcification caused by KD in young adults except for small children. Re-stenosis within the first year after PTCRA often develops because of reactive intimal thickening after the procedure. If a target vessel is a patent 1 year after the procedure, long-term patency may be expected in patients more than 10 years old.

Keywords

Kawasaki diseasecoronary artery diseaselocalised stenosiscoronary artery calcificationpercutaneous transluminal coronary rotational atherectomyrestenosis
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 2 , February 2022 , pp. 287 - 294
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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