Abstract 2450: Long-term Clinical Follow-up After Rotational Atherectomy to Coronary Arterial Stenosis in Kawasaki Disease
Background: Although rotational atherectomy (RA) have been proven to be effective in calcified and non-dilatable lesions in Kawasaki disease, long-term efficacy and safety have not been established.
Method: To evaluate long-term outcome, follow-up (FU) information was analyzed in 26 patients with Kawasaki disease, or 33 calcified and non-dilatable lesions with adjunctive balloon (BA) dilatation after RA from May 1993 to December 2002. Patient and lesion characteristics were: age 15±5 (8 –28) years(yrs), and male-77%, previous myocardial infarction (MI)-8%, multi-vessel disease-31%, coronary aneurysm-85%. Lesion location was LAD-58%, RCA-36%, LCX-6%. Successful dilatation was achieved in 30 out of 30 lesions (100%) with adjunctive BA after RA. There were no in-hospital major events (Death/MI/coronary artery bypass surgery: CABG) and angiographic complications (perforation, no-reflow, spasm).
Results: Six-month FU quantitative coronary angiography (QCA) was performed in 26 patients or 33 lesions (100%). Binary restenosis (defined as >50% diameter stenosis at FU) was detected in 9 of 33lesions (27%). Target lesion (TL) - percutaneous coronary intervention (PCI) was performed in 8 of 33 lesions (24%). Neoaneurysm was occurred in 4 of 33 lesions (12%) which was associated with post % diameter stenosis (P=0.002) and the crack of calcified arch detected by intravascular ultrasoud examination after adjunctive BA dilatation (P=0.03). Anti-coagulant therapy was performed in all patients with neoaneurysm. Clinical FU data was achieved in all patients. Mean clinical FU interval was 8.4±2.4 yrs. Event-free survival rates at 8 yrs were as follows: Death 100%, Death/MI/CABG 100%, Death/MI/CABG/TL-PCI 73%, Death/MI/CABG/Any-PCI 73%. There was no any-PCI beyond 6 months.
Conclusion: RA is an effective treatment in calcified and non-dilatable lesions with Kawasaki disease, associated with high procedural success rates. The safety and efficacy of RA appeared to be sustained at long-term FU.