Objectives: Optical coherence tomography (OCT) is an intracoronary arterial imaging modality employing near-infrared light to create images. OCT makes it possible to distinguish the three layers of the coronary arterial wall. However, few previous studies have used OCT to evaluate coronary arterial lesions (CAL) in Kawasaki disease (KD). Here we report the use of OCT to evaluate CALs in KD.
Patients and Methods: Fifteen patients aged between 11 and 29 years were admitted to undergo coronary angiography (CAG) for follow-up of KD. The male : female ratio was 11:4. Their ages at disease onset and when OCT was performed were 1m - 10y11m (median; 1y2m), and 11y1m - 29y3m (median; 16y2m), respectively. The interval between disease onset and OCT examination was 5y1m - 24y4m (median; 13y2m). Repeated CAG was performed on the basis of the criteria stipulated in the guidelines for cardiovascular sequelae in KD (JCS 2008). At the time of the latest CAG, we performed not only regular CAG but also IVUS and OCT (C7 OCT imaging system, St Jude Medical, St. Paul, MN, USA) for coronary arteries between December 2012 and August 2014.
Results: We demonstrated fresh thrombus, stenosis, fibrotic intimal thickening with lamellar calcification and partial disappearance of the tunica media in CAL. Fibrotic intimal thickening and disruption of the tunica media are demonstrated in all patients. In addition, OCT demonstrated intimal thickening and disruption of the tunica media in completely regressed lesions and even in regions where CAG had shown normal coronary arterial walls in the acute phase.
Conclusions: Our data suggest that fibrotic intimal thickening and disruption of the tunica media may be basic changes of coronary arterial sequelae in KD. The use of OCT for evaluation of KD vasculitis may clarify the mechanisms responsible for coronary arterial sequelae and be useful for prognostication of CAL.