[Intracoronary thrombolytic therapy in Kawasaki disease and the usefulness of two-dimensional echocardiography in detecting intracoronary thrombi]

Abstract

The main cause of death in patients with Kawasaki disease is myocardial infarction due to thrombotic occlusion of a coronary aneurysm. Intracoronary thrombolytic therapy was administered to dissolve the intracoronary thrombi of one infarcted patient and five non-infarcted patients who had massive intracoronary thrombus formations which were detected by two-dimensional echocardiography (2-D echo). Intracoronary injections of Urokinase ranged in dose from 2000 to 240000 IU. Systemic Urokinase infusions were performed for two patients in addition to intracoronary injections. Coronary angiography revealed complete obstruction of coronary aneurysms in two patients and partial obstruction in one patient. Although coronary angiography failed to visualize the intracoronary thrombi in three patients, 2-D echocardiography imaged massive thrombus formations in coronary aneurysms. Partial but significant coronary arterial recanalization was achieved after injecting Urokinase in a patient with myocardial infarction. Complete resolution of massive intracoronary thrombi was observed in three of five patients using 2-D echocardiography. A decrease in size of the intracoronary thrombus in one patient was observed after thrombolytic therapy. In another patient, the size of a thrombus did not change after thrombolytic therapy. Recurrence of thrombus formation in coronary aneurysms was observed in three patients using serial 2-D echocardiography. Urokinase was readministered to them and one showed significant reduction in the thrombus size. We conclude that 1) 2-D echocardiography is more sensitive and reproducible than coronary angiography. Therefore, serial 2-D echocardiography should be performed for patients with Kawasaki disease to detect intracoronary thrombus formation and to evaluate serial changes in thrombi. 2) Intracoronary thrombolytic therapy is useful for patients who have intracoronary thrombi to treat or prevent myocardial infarction.