[Long-term clinical follow-up after rotational atherectomy to coronary arterial stenosis in kawasaki disease].
BACKGROUND
Although rotational atherectomy (RA) have been proven to be effective in calcified and non-dilatable lesions in Kawasaki disease, long-term efficacy and safety have not been established.


METHODS
To evaluate long-term outcome, follow-up (FU) information was analyzed in 26 patients with Kawasaki disease, or 30 calcified and non-dilatable lesions with adjunctive balloon(BA) dilatation after RA from May 1993 to December 2002. Patient and lesion characteristics were: age 15 +/- 5 (8-28) years(yrs), and male-77%, previous myocardial infarction(MI)-4%, multi-vessel disease-35%, coronary aneurysm-87%. Lesion location was LAD-53%, RCA-40%, LCX-7%. Successful dilatation was achieved in 30 out of 30 lesions (100%) with adjunctive BA after RA. There were no in-hospital major events (Death/MI/coronary artery bypass surgery: CABG) and angiographic complications (perforation, no-reflow, spasm).


RESULTS
Six-month FU quantitative coronary angiography(QCA) was performed in 23 patients or 27 lesions (90%). Binary restenosis (defined as > 50% diameter stenosis at FU) was detected in 4 of 27 lesions (15%). Target lesion(TL)-percutaneous coronary intervention(PCI) was performed in 3 of 27 lesions (11%). Neoaneurysm was occurred in 4 of 27 lesions (15%) which was associated with post % diameter stenosis (p = 0.002) and the crack of calcified arch detected by intravascular ultrasoud examination after adjunctive BA dilatation (p = 0.03). Anti-coagulant therapy was performed in all patients with neoaneurysm. Clinical FU data was achieved in all patients. Mean clinical FU interval was 6.1 +/- 3.4 yrs. Event-free survival rates at 5 yrs were as follows: Death 100%, Death/MI/CABG 100%, Death/MI/CABG/TL-PCI 86%, Death/MI/CABG/Any-PCI 86%. There was no any- PCI beyond 6 months.


CONCLUSIONS
RA is an effective treatment in calcified and non-dilatable lesions with Kawasaki disease, associated with high procedural success rates. The safety and efficacy of RA appeared to be sustained at long-term FU.
Yokoi
Hiroyoshi
H
Kokura Memorial Hospital.
D000293:Adolescent; D000328:Adult; D017225:Atherectomy, Coronary; D002648:Child; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000601:surgery*; D016896:Treatment Outcome