Original Articles
Catheter interventional treatment in Kawasaki disease: A report from the Japanese Pediatric Interventional Cardiology Investigation Group

https://doi.org/10.1067/mpd.2000.107164Get rights and content

Abstract

Objective: To assess the current status of catheter intervention in Kawasaki disease and to evaluate its efficacy and outcome. Study design: A questionnaire was sent to 55 major institutions in Japan. Results: A total of 58 procedures in 57 patients were reported. The median age at the time of intervention was 12.1 years. The procedures included percutaneous transluminal coronary angioplasty (PTCA; n = 34), percutaneous transluminal coronary rotational ablation (PTCRA; n = 13), directional coronary atherectomy (DCA; n = 4), and stent implantation (n = 7). The immediate success rate was 74% for PTCA, 100% for PTCRA, 100% for DCA, and 86% for stents. The interval from the onset of disease to intervention in successful PTCA (n = 25) was significantly shorter than that in unsuccessful PTCA (n = 9). Restenosis after PTCA was observed in 24%. Development of new coronary aneurysms was reported in 3 patients for PTCA, 2 for PTCRA, 3 for DCA, and 1 for stents. Except for the DCA, all new aneurysms were associated with the use of high-pressure balloon inflation. Two deaths were reported as acute complications. Conclusions: Catheter intervention is a promising therapeutic strategy in the management of coronary stenosis caused by Kawasaki disease. Care should be paid to avoid acute coronary arterial complications and the development of new coronary aneurysms. (J Pediatr 2000;137:181-6)

Section snippets

Questionnaires

The first questionnaire, which addressed whether catheter interventions were performed to treat coronary artery lesions in patients with Kawasaki disease before December 1997, was sent to 55 institutions with faculty who were members of the Japanese Pediatric Interventional Cardiology Investigation group. A total of 58 procedures in 57 patients were reported by 10 institutions. For these patients a second questionnaire, which addressed the type of procedure, the age at the time of intervention,

Results

There were 46 male and 11 female patients in the study. The age at the onset of disease ranged from 3 months to 10.1 years (median 1.6 years). The age at the time of catheter intervention ranged from 11 months to 24 years (median 12.1 years). The interval from the onset of disease to catheter intervention ranged from 2 months to 22.6 years (median 9.8 years).

Discussion

Several types of catheter intervention for the treatment of patients with Kawasaki disease have been reported.4, 5, 6, 7, 8, 9, 10, 11 Although these preliminary reports demonstrated the efficacy of each procedure, the studies were limited.

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Reprint requests: Teiji Akagi, MD, Department of Pediatrics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan 830-0011.

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