The Relation between Calcification and Restenosis of Coronary Artery after Percutaneous Transluminal Coronary Rotational Ablation (PTCRA) in Kawasaki Disease

Background: Severe calcification in the coronary lesions has been frequently revealed in Kawasaki disease (KD). Therefore, PTCRA has been performed as an effective intervention for obstructive coronary lesions. However, restenosis after PTCRA in KD has not been clear. So, we assessed the relation between calcification and restenosis after PTCRA in KD using the intravascular ultrasound (IVUS) in two KD patients. Case reports: Case1; 13 year-old boy, 9 years after the onset of KD, developed 90% stenosis both at AHA segments 2 and 6 on CAG. PTCRA was performed for these stenotic lesions, and consequently stent implantation was added at segment 6 because of intimal dissection after additional PTCA. Stenosis at segments 2 and 6 reduced to 25% and 0%, respectively. IVUS revealed partial circumferential calcification at segment 2, and total calcification at segment 6. Three months later, the follow-up CAG and IVUS showed 50% restenosis and partial circumferential calcification with intimal thickning at segment 2. On the other hand, they showed no restenosis and total calcification without intimal thickning at segment 6. Case2; 16 year-old boy, 14 years after onset of KD, developed 90% stenosis at segment 6, and total occlusion of RCA with recanalization. Stenotic lesion at segment 6 was improved to 50% by PTCRA. Three months later, follow-up CAG and IVUS showed no restenosis and total calcification without intimal thickning. Conclusion: PTCRA was performed for three calcified stenotic lesions in 2 KD patients. One, with partial circumferential calcification, caused a restenotic change with developed intimal thickning. On the other hand, other 2 lesions with total calcification did not develop restenosis. These results suggest that total calcification could protect intimal proliferation contributing to coronary restenosis after PTCRA.