- Email: [email protected]
Evaluation of Coronary Arterial Lesions Due to Kawasaki Disease Using Optical Coherence Tomography
Accepted Manuscript Evaluation of coronary arterial lesions due to Kawasaki disease using optical coherence tomography Nobuyuki Kakimoto, MD Hiroyuki Suzuki, MD, PhD Takashi Kubo, MD, PhD Tomohiro Suenaga, MD Takashi Takeuchi, MD Shoichi Shibuta, MD Yasushi Ino, MD Takashi Akasaka, MD, PhD Norishige Yoshikawa, MD, PhD PII:
S0828-282X(14)00294-3
DOI:
10.1016/j.cjca.2014.04.028
Reference:
CJCA 1204
To appear in:
Canadian Journal of Cardiology
Received Date: 4 February 2014 Revised Date:
28 April 2014
Accepted Date: 28 April 2014
Please cite this article as: Kakimoto N, Suzuki H, Kubo T, Suenaga T, Takeuchi T, Shibuta S, Ino Y, Akasaka T, Yoshikawa N, Evaluation of coronary arterial lesions due to Kawasaki disease using optical coherence tomography, Canadian Journal of Cardiology (2014), doi: 10.1016/j.cjca.2014.04.028. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT
Title: Evaluation of coronary arterial lesions due to Kawasaki disease using optical
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coherence tomography
Nobuyuki Kakimoto, MDa, Hiroyuki Suzuki, MD, PhDa, Takashi Kubo, MD, PhDb,
SC
Tomohiro Suenaga, MDa, Takashi Takeuchi, MDa, Shoichi Shibuta, MDc, Yasushi Ino,
a
Department of Pediatrics and bDepartment of Cardiovascular Medicine, Wakayama
Medical University, Wakayama, Japan
Department of Pediatrics, Kinan Hospital, Tanabe, Japan
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c
M AN U
MDb, Takashi Akasaka, MD, PhDb, Norishige Yoshikawa, MD, PhDa
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EP
Short title: Evaluation of CALs due to KD using OCT
Correspondence :
Hiroyuki Suzuki MD, PhD Department of Pediatrics, Wakayama Medical University 811-1 Kimiidera, Wakayama, 641-0012, Japan Telephone: +81-73-441-0633
E-mail: [email protected]
2
ACCEPTED MANUSCRIPT
Abstract: Optical coherence tomography (OCT) is a high-resolution intracoronary arterial
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imaging modality. We describe two patients who were admitted to undergo coronary angiography (CAG) and OCT for follow-up of Kawasaki disease (KD) with coronary
SC
artery aneurysms. OCT clearly demonstrated thrombus, stenosis, fibrotic intimal
M AN U
thickening with lamellar calcification and partial disappearance of the tunica media at the aneurysm site. In addition, focal calcification, intimal thickening and medial irregularity were observed even in regions of coronary arterial walls that appeared to be
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EP
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normal by CAG. OCT is useful for evaluating coronary arterial sequelae of KD.
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ACCEPTED MANUSCRIPT
Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality that is able to distinguish the three layers of the coronary arterial wall:
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the intima, media, and adventitia1. However, few studies have used OCT to evaluate coronary arterial lesions (CAL)2 in patients with Kawasaki disease (KD). We report the
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SC
precise evaluation of coronary arteries in KD sequelae using OCT.
Case 1
An 18-year-old male was admitted to undergo coronary angiography (CAG) for follow-up of KD, which had developed when he had been 8 months old and caused
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coronary artery aneurysms in segments 1, 2, 6, and 11. Since then, he had been treated with aspirin and warfarin orally, and had suffered no cardiac events. Repeated CAG
EP
based on the KD guideline3 had shown that the sizes of the coronary aneurysms had not
AC C
changed. At the time of the latest CAG, we performed not only regular CAG but OCT (C7 OCT imaging system, St Jude Medical, St. Paul, MN, USA). Unexpectedly, OCT demonstrated thrombus and stenosis at the inlet of the aneurysm, and fibrotic intimal thickening with lamellar calcification and partial disappearance of the tunica media at the aneurysm site. In addition, focal calcification and medial irregularity were observed even in regions where CAG had demonstrated apparently normal coronary arterial walls
4
ACCEPTED MANUSCRIPT
(Figure 1).
RI PT
Case 2
A 15-year-old female was admitted to undergo CAG for follow-up of KD. She had
SC
suffered from KD at 9 years of age and this had caused coronary artery aneurysms in
M AN U
segments 2 and 3 and dilatation of segment 5. At the latest CAG study, aneurysms had already regressed and there were no stenotic lesions. OCT demonstrated intimal thickening and partial disruption of the tunica media at the regressed aneurysm site. Surprisingly, intimal thickening and partial disruption of the tunica media were
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Discussion
EP
acute phase (Figure 2).
TE D
observed in regions of the coronary arterial walls that appeared normal by CAG in the
Although some reports have documented the use of IVUS for evaluation of CAL in KD patients4, few studies have used OCT2. Our present study demonstrated fresh thrombus, stenosis, fibrotic intimal thickening with lamellar calcification and partial disappearance of the tunica media in CAL. In addition, OCT demonstrated intimal thickening and disruption of the tunica media not only in areas where the lesions had
5
ACCEPTED MANUSCRIPT
completely regressed but also in regions of coronary arterial walls that appeared normal by CAG in the acute phase.
RI PT
These findings suggest that OCT may be a very useful modality for analysis of coronary arteries in KD patients. Many autopsy reports have described analysis of the
SC
coronary arterial walls of CAL associated with KD5. In those studies, localized intimal
M AN U
thickening was evident even in regions without aneurysm formation. Therefore, OCT may clarify the time course of pathological changes in coronary arteries. However, OCT has some limitations. As the distance of axial penetration in OCT is 2 mm at most, it is not possible to analyze the walls of giant aneurysms. In addition, it is
TE D
impossible to perform OCT in areas distal to severe stenotic lesions. In conclusion, OCT for evaluation of KD vasculitis may clarify the mechanisms
AC C
EP
responsible for coronary arterial sequelae and be useful for prognostication of CAL.
Disclosure:
The authors have no conflicts of interest to disclose.
Figure legends: Figure 1: Case 1, CAG and OCT findings: (A) RCA between two aneurysms shows
6
ACCEPTED MANUSCRIPT
fibrotic intimal thickening. (B) Proximal portion of the distal aneurysm; fresh thrombus (*) and stenosis. (C) inner portion of the distal aneurysm; lamellar calcification (arrows),
RI PT
disruption and disappearance of the media (arrowheads). (D) inside of the aneurysm in LAD; fibrotic intimal thickening and lamellar calcification (arrow), disruption and
M AN U
SC
disappearance of the media (**) .
Figure 2: Case 2, CAG findings: 1 month after onset (A): there are two aneurysms (arrows) and latest (B): they have regressed. OCT findings: These panels (C-F) show intimal thickening and disruption of the media (arrowheads). C (segments 1) and E
1.
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References:
EP
aneurysm regression.
TE D
(segment 3), which appear normal by CAG in the acute phase. (D and F) sites of
Akasaka T, Kubo T, Mizukoshi M, et al. Pathophysiology of acute coronary syndrome assessed by optical coherence tomography. J Cardiol. 2010; 56:8-14.
2.
Fujino Y, Attizzani GF, Tahara S, et al. Frequency-domain optical coherence tomography evaluation of a patient with Kawasaki disease and severely calcified plaque. Int J Cardiol. 2014;171:281-3.
7
ACCEPTED MANUSCRIPT
3.
JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)-digest version. Circ J.
4.
RI PT
2010;74:1989-2020.
Mitani Y, Ohashi H, Sawada H, et al. In vivo plaque composition and morphology
SC
in coronary artery lesions in adolescents and young adults long after Kawasaki
M AN U
disease: a virtual histology-intravascular ultrasound study. Circulation. 2009; 119:2829-36. 5.
Takahashi K, Oharaseki T, Naoe S. Pathological study of postcoronary arteritis in adolescents and young adults: with reference to the relationship between sequelae
TE D
of Kawasaki disease and atherosclerosis. Pediatr Cardiol. 2001;22:138-42.
EP
Summary:
Optical coherence tomography (OCT) clearly showed a thrombus, stenosis, fibrotic
AC C
intimal thickening with lamellar calcification and partial disappearance of the tunica media at coronary arterial lesions complicated with Kawasaki disease (KD). In addition, focal calcification and medial irregularity were observed even in regions looking like normal coronary arterial walls. OCT is useful for evaluating coronary arterial sequelae of KD.
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EP
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M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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EP
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M AN U
SC
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ACCEPTED MANUSCRIPT
S0828-282X(14)00294-3
DOI:
10.1016/j.cjca.2014.04.028
Reference:
CJCA 1204
To appear in:
Canadian Journal of Cardiology
Received Date: 4 February 2014 Revised Date:
28 April 2014
Accepted Date: 28 April 2014
Please cite this article as: Kakimoto N, Suzuki H, Kubo T, Suenaga T, Takeuchi T, Shibuta S, Ino Y, Akasaka T, Yoshikawa N, Evaluation of coronary arterial lesions due to Kawasaki disease using optical coherence tomography, Canadian Journal of Cardiology (2014), doi: 10.1016/j.cjca.2014.04.028. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT
Title: Evaluation of coronary arterial lesions due to Kawasaki disease using optical
RI PT
coherence tomography
Nobuyuki Kakimoto, MDa, Hiroyuki Suzuki, MD, PhDa, Takashi Kubo, MD, PhDb,
SC
Tomohiro Suenaga, MDa, Takashi Takeuchi, MDa, Shoichi Shibuta, MDc, Yasushi Ino,
a
Department of Pediatrics and bDepartment of Cardiovascular Medicine, Wakayama
Medical University, Wakayama, Japan
Department of Pediatrics, Kinan Hospital, Tanabe, Japan
TE D
c
M AN U
MDb, Takashi Akasaka, MD, PhDb, Norishige Yoshikawa, MD, PhDa
AC C
EP
Short title: Evaluation of CALs due to KD using OCT
Correspondence :
Hiroyuki Suzuki MD, PhD Department of Pediatrics, Wakayama Medical University 811-1 Kimiidera, Wakayama, 641-0012, Japan Telephone: +81-73-441-0633
E-mail: [email protected]
2
ACCEPTED MANUSCRIPT
Abstract: Optical coherence tomography (OCT) is a high-resolution intracoronary arterial
RI PT
imaging modality. We describe two patients who were admitted to undergo coronary angiography (CAG) and OCT for follow-up of Kawasaki disease (KD) with coronary
SC
artery aneurysms. OCT clearly demonstrated thrombus, stenosis, fibrotic intimal
M AN U
thickening with lamellar calcification and partial disappearance of the tunica media at the aneurysm site. In addition, focal calcification, intimal thickening and medial irregularity were observed even in regions of coronary arterial walls that appeared to be
AC C
EP
TE D
normal by CAG. OCT is useful for evaluating coronary arterial sequelae of KD.
3
ACCEPTED MANUSCRIPT
Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality that is able to distinguish the three layers of the coronary arterial wall:
RI PT
the intima, media, and adventitia1. However, few studies have used OCT to evaluate coronary arterial lesions (CAL)2 in patients with Kawasaki disease (KD). We report the
M AN U
SC
precise evaluation of coronary arteries in KD sequelae using OCT.
Case 1
An 18-year-old male was admitted to undergo coronary angiography (CAG) for follow-up of KD, which had developed when he had been 8 months old and caused
TE D
coronary artery aneurysms in segments 1, 2, 6, and 11. Since then, he had been treated with aspirin and warfarin orally, and had suffered no cardiac events. Repeated CAG
EP
based on the KD guideline3 had shown that the sizes of the coronary aneurysms had not
AC C
changed. At the time of the latest CAG, we performed not only regular CAG but OCT (C7 OCT imaging system, St Jude Medical, St. Paul, MN, USA). Unexpectedly, OCT demonstrated thrombus and stenosis at the inlet of the aneurysm, and fibrotic intimal thickening with lamellar calcification and partial disappearance of the tunica media at the aneurysm site. In addition, focal calcification and medial irregularity were observed even in regions where CAG had demonstrated apparently normal coronary arterial walls
4
ACCEPTED MANUSCRIPT
(Figure 1).
RI PT
Case 2
A 15-year-old female was admitted to undergo CAG for follow-up of KD. She had
SC
suffered from KD at 9 years of age and this had caused coronary artery aneurysms in
M AN U
segments 2 and 3 and dilatation of segment 5. At the latest CAG study, aneurysms had already regressed and there were no stenotic lesions. OCT demonstrated intimal thickening and partial disruption of the tunica media at the regressed aneurysm site. Surprisingly, intimal thickening and partial disruption of the tunica media were
AC C
Discussion
EP
acute phase (Figure 2).
TE D
observed in regions of the coronary arterial walls that appeared normal by CAG in the
Although some reports have documented the use of IVUS for evaluation of CAL in KD patients4, few studies have used OCT2. Our present study demonstrated fresh thrombus, stenosis, fibrotic intimal thickening with lamellar calcification and partial disappearance of the tunica media in CAL. In addition, OCT demonstrated intimal thickening and disruption of the tunica media not only in areas where the lesions had
5
ACCEPTED MANUSCRIPT
completely regressed but also in regions of coronary arterial walls that appeared normal by CAG in the acute phase.
RI PT
These findings suggest that OCT may be a very useful modality for analysis of coronary arteries in KD patients. Many autopsy reports have described analysis of the
SC
coronary arterial walls of CAL associated with KD5. In those studies, localized intimal
M AN U
thickening was evident even in regions without aneurysm formation. Therefore, OCT may clarify the time course of pathological changes in coronary arteries. However, OCT has some limitations. As the distance of axial penetration in OCT is 2 mm at most, it is not possible to analyze the walls of giant aneurysms. In addition, it is
TE D
impossible to perform OCT in areas distal to severe stenotic lesions. In conclusion, OCT for evaluation of KD vasculitis may clarify the mechanisms
AC C
EP
responsible for coronary arterial sequelae and be useful for prognostication of CAL.
Disclosure:
The authors have no conflicts of interest to disclose.
Figure legends: Figure 1: Case 1, CAG and OCT findings: (A) RCA between two aneurysms shows
6
ACCEPTED MANUSCRIPT
fibrotic intimal thickening. (B) Proximal portion of the distal aneurysm; fresh thrombus (*) and stenosis. (C) inner portion of the distal aneurysm; lamellar calcification (arrows),
RI PT
disruption and disappearance of the media (arrowheads). (D) inside of the aneurysm in LAD; fibrotic intimal thickening and lamellar calcification (arrow), disruption and
M AN U
SC
disappearance of the media (**) .
Figure 2: Case 2, CAG findings: 1 month after onset (A): there are two aneurysms (arrows) and latest (B): they have regressed. OCT findings: These panels (C-F) show intimal thickening and disruption of the media (arrowheads). C (segments 1) and E
1.
AC C
References:
EP
aneurysm regression.
TE D
(segment 3), which appear normal by CAG in the acute phase. (D and F) sites of
Akasaka T, Kubo T, Mizukoshi M, et al. Pathophysiology of acute coronary syndrome assessed by optical coherence tomography. J Cardiol. 2010; 56:8-14.
2.
Fujino Y, Attizzani GF, Tahara S, et al. Frequency-domain optical coherence tomography evaluation of a patient with Kawasaki disease and severely calcified plaque. Int J Cardiol. 2014;171:281-3.
7
ACCEPTED MANUSCRIPT
3.
JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)-digest version. Circ J.
4.
RI PT
2010;74:1989-2020.
Mitani Y, Ohashi H, Sawada H, et al. In vivo plaque composition and morphology
SC
in coronary artery lesions in adolescents and young adults long after Kawasaki
M AN U
disease: a virtual histology-intravascular ultrasound study. Circulation. 2009; 119:2829-36. 5.
Takahashi K, Oharaseki T, Naoe S. Pathological study of postcoronary arteritis in adolescents and young adults: with reference to the relationship between sequelae
TE D
of Kawasaki disease and atherosclerosis. Pediatr Cardiol. 2001;22:138-42.
EP
Summary:
Optical coherence tomography (OCT) clearly showed a thrombus, stenosis, fibrotic
AC C
intimal thickening with lamellar calcification and partial disappearance of the tunica media at coronary arterial lesions complicated with Kawasaki disease (KD). In addition, focal calcification and medial irregularity were observed even in regions looking like normal coronary arterial walls. OCT is useful for evaluating coronary arterial sequelae of KD.
AC C
EP
TE D
M AN U
SC
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ACCEPTED MANUSCRIPT
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EP
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M AN U
SC
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ACCEPTED MANUSCRIPT