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. 2015 May 19;4(5):e001939.
doi: 10.1161/JAHA.115.001939.

Coronary Wall Structural Changes in Patients With Kawasaki Disease: New Insights From Optical Coherence Tomography (OCT)

Audrey Dionne  1 , Ragui Ibrahim  2 , Catherine Gebhard  3 , Mohamed Bakloul  4 , Jean-Bernard Selly  5 , Mohamed Leye  1 , Julie Déry  6 , Chantale Lapierre  6 , Patrice Girard  1 , Anne Fournier  1 , Nagib Dahdah  1
Affiliations

Coronary Wall Structural Changes in Patients With Kawasaki Disease: New Insights From Optical Coherence Tomography (OCT)

Audrey Dionne et al. J Am Heart Assoc. .

Abstract

Background: Coronary artery aneurysms (CAA) are serious complications of Kawasaki disease (KD). Optical coherence tomography (OCT) is a high-resolution intracoronary imaging modality that characterizes coronary artery wall structure. The purpose of this work was to describe CAA wall sequelae after KD.

Methods and results: KD patients scheduled for routine coronary angiography underwent OCT imaging between March 2013 and August 2014. Subjects' clinical courses, echocardiography, and coronary angiography examinations were reviewed retrospectively. OCT was performed in 18 patients aged 12.4±5.5 years, 9.0±5.1 years following onset of KD. Of those, 14 patients (77.7%) had a history of CAA (7 with giant CAA and 7 with regressed CAA at time of OCT). Intracoronary nitroglycerin was given to all patients (88.4±45.5 μg/m(2)). Mean radiation dose was 10.9±5.2 mGy/kg. One patient suffered from a transitory uneventful vasospasm at the site of a regressed CAA; otherwise no major procedural complications occurred. The most frequent abnormality observed on OCT was intimal hyperplasia (15 patients, 83.3%) seen at both aneurysmal sites and angiographically normal segments amounting to 390.8±166.0 μm for affected segments compared to 61.7±17 μm for unaffected segments (P<0.001). Disappearance of the media, and presence of fibrosis, calcifications, macrophage accumulation, neovascularization, and white thrombi were seen in 72.2%, 77.8%, 27.8%, 44.4%, and 33.3% of patients.

Conclusions: In this study, OCT proved safe and insightful in the setting of KD, with the potential to add diagnostic value in the assessment of coronary abnormalities in KD. The depicted coronary structural changes correspond to histological findings previously described in KD.

Keywords: coronary disease; imaging; pediatrics.

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Figures

Figure 1
Figure 1
Normal coronary artery with intima (white measure) and media (blue measure) being well delineated and of normal thickness.
Figure 2
Figure 2
Concentric intimal hyperplasia (white measure) with preserved 3-layered structure of the vessel wall.
Figure 3
Figure 3
Severe concentric intimal thickening (yellow and green measures) with loss of the normal structure of the vessel wall, disappearance of media (red arrow), and nonobstructive luminal narrowing.
Figure 4
Figure 4
Intimal hyperplasia (white measure) with medial irregularities most likely due to fibrosis (red arrow) with diffuse medial thickening.
Figure 5
Figure 5
Calcified nodule (pink measure), characterized by a well-demarcated border and heterogeneous, low-signal composition.
Figure 6
Figure 6
Intimal hyperplasia (green measure) with macrophage accumulation (red arrow): signal-rich band, strongly light-attenuating and causing an underlying signal-poor region.
Figure 7
Figure 7
White thrombus (white and blue measures), characterized by a signal-rich, irregular mass protruding into the lumen with mild light attenuation (as opposed to red thrombus).
Figure 8
Figure 8
Intimal hyperplasia (pink measure) with ellipsoid structures of varying size with a dark appearance suggesting microvessels, a typical picture seen in neovascularization (red arrow).
Figure 9
Figure 9
Coronary artery showing severe intimal hyperplasia (yellow measure) with resulting stenosis (red arrow).
See this image and copyright information in PMC

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