Abstract 159: New Insight of Coronary Wall Structural Changes from an Optical Coherence Tomography (OCT) study Following Kawasaki Disease.

Abstract

Background: Coronary artery aneurysms (CAA) are a serious complication of Kawasaki disease (KD). Coronary imaging usually describes aneurysms, stenosis and dilatation. Optical coherence tomography (OCT) is a technique useful for intracoronary imaging and coronary wall structure characterization. Method: KD patients scheduled for routine coronary angiography underwent OCT imaging between June 2013 and August 2014. Subjects’ clinical courses with echocardiography and angiography were reviewed to contrast with OCT findings. Results: OCT was performed on 18 patients 9.0 ± 5.1 years after KD at 12.4 ± 5.5 yo (range 3.5-21 yo). Of those, 14 (77.7%) had a history of CAA (7 giant CAA, 7 regressed CAA at time of OCT). Prophylactic intracoronary nitroglycerin was given (88.4 ± 45.5 μg/m2). Total X-ray exposure was 10.9 mGy/kg. One patient had a transitory uneventful vasospasm at the site of a former CAA, otherwise no major complications occurred (such as dissection, thrombosis, ischemia, arrhythmia). OCT findings were intimal hyperplasia in 15/18 (83.3%) on aneurysmal and regressed aneurysm segments. Intimal hyperplasia measured 390.8 ± 166.0 μm for the affected segments, compared to 61.7 ± 17.0 μm for the unaffected segments (p<0.001). Destroyed media, fibrosis, calcifications, macrophage infiltration, neovascularization and white thrombus were also seen (Table 1). In two cases with previously implanted stent, the neo-intima was identified, measuring 80-160 μm. Conclusion: In our experience, OCT proved safe and insightful in the setting of KD. The observed coronary structural changes correspond to histological findings described in the literature late after KD.