Coronary Intervention in Kawasaki Disease

Kawasaki disease (KD) is an acute febrile illness of childhood that can lead to coronary artery aneurysms (CAAs), increasing the risk of thrombosis, stenosis, myocardial infarction (MI), and long-term cardiovascular events. Coronary complications are associated with giant aneurysms, male sex, and resistance to immunoglobulin therapy. MI symptoms are often non-specific, especially in young children, with the highest risk occurring within three months after disease onset. Revascularization strategies, adapted from adult acute coronary syndrome guidelines, include primary percutaneous coronary intervention (PCI), thrombolysis, and coronary artery bypass grafting (CABG), depending on timing, anatomy, and patient size. PCI is often challenging in this population due to small vessel size, heavy calcification, and luminal proliferation. Available treatment options include balloon angioplasty, stent implantation, rotational atherectomy, and intravascular lithotripsy. Balloon angioplasty in KD patients requires caution due to the risk of neo-aneurysm formation, particularly with high-pressure balloon dilatation. Thrombolysis remains an important option when PCI is not feasible. CABG, particularly using arterial grafts, offers excellent long-term patency and remains preferred for complex disease. Although PCI has higher re-intervention rates, long-term survival after PCI and CABG is comparable. Tailored approaches considering lesion complexity, hemodynamics, and patient-specific factors are essential in managing coronary complications in KD.