Treatment of thrombosis in KD Patients using tissue plasminogen activator: a single center study

Fig. 1. In Patient 1, ECHO showed the thrombus formed in the LAD and the lumen was nearly blocked (a) 2 months after the onset of the disease. After 2 months of thrombolysis treatment, the thrombus disappeared completely (b), and no contrast filling defect was found in the LAD in CTCA (c). Bilateral coronary arteries presented with irregular and marked dilation (d)

Fig. 2. In Patient 2, ECHO showed RCA dilated to 9 mm at 16 days of illness (a). At 30 days of illness, thrombus with relatively high density (2.6 × 3.2 mm, b-red arrow) was found and convex to the lumen in RCA (b). The thrombolytic treatment began six days later, and the thrombus disappeared after 10 days treatment (c). Coronary artery CTCA showed aneurysm in RCA and distal blood flow were clearly at 30 days of illness (d). At 17 months of illness onset, CTCA at a different hospital detected reoccurred thrombosis at the distal end of RCA, and it blocked the blood flow (e). After thrombolysis treatment for 2 months, the distal blood flow almost recovered (f)

Fig. 3. ECHO showed LAD aneurysmal dilatation at 14 days of illness in Patient 3 (a). At 5.5 years of illness, ECHO showed strong density thromboses in LAD (b). At 6.5 years of illness, ECHO showed mixed density thromboses (the strong echo mixed with the weak echo) in LAD (c) CTCA showed LAD dilatation with contrast agent filling defect (thrombus) (d). After 9 days of thrombolytic/anticoagulant/antiplatelet treatment, the low density portion (the newly formed thrombus) disappeared and patient’s symptoms of chest tightness disappeared (e). After 8 months of thrombolytic/anticoagulant/antiplatelet treatment, the strong density portion (the previously formed thrombus) disappeared, too (f)

Fig. 4. ECHO showed LM aneurysmal dilatation and filling with strong echo thrombosis 6.2 × 2.6 mm at 15 days of illness in Patient 4 (a). Treatment started with alteplase. 3days later, ECHO still showed thrombus in LM (b). At 22 days of illness onset, contrast filling defect wasn’t observed in CTCA (c) and at the same time ECHO showed a small thrombus in LM (d). At 27 days of illness, ECHO showed that the thrombus was reduced to 2.3 × 1.9 mm (e). At 32 days of illness, the thrombus was diminished in ECHO (f)

Fig. 5. In patient 1, ECG was normal when thrombosis reoccurred in LAD at 2 months of KD onset (a). In Patient 2, ECG showed downward ST segment at the low and lateral wall when the thrombosis reoccurred at the distal end of RCA. The thrombosis blocked the blood flow at 16 months of KD onset (b). Patient 3 had a normal ECG results when he had chest pain during exercises, and the thrombosis was detected in LAD at 6.5 years of KD onset (c). In Patient 4, ECG was normal when thrombosis was detected at 15 days from onset of illness (d)