Lipid-rich plaque in possible coronary sequelae of Kawasaki disease detected by optical frequency domain imaging
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CASE REPORT
Lipid-rich plaque in possible coronary sequelae of Kawasaki disease detected by optical frequency domain imaging Jun Shiraishi • Masaki Yashige • Masayuki Hyogo Takatomo Shima • Takahisa Sawada • Yoshio Kohno
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Received: 27 August 2014 / Accepted: 18 October 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract Potential risk for early development of atherosclerosis in patients with antecedent-Kawasaki disease (KD) is now attracting more attention. A 47-year-old man was admitted to our hospital because of calcification exclusively in the proximal segment of left anterior descending coronary artery (LAD) on chest CT. Coronary CT revealed a severe stenosis at the inlet of the aneurysm with eggshell-like calcification in the proximal LAD, highly suspecting the presence of coronary sequelae of KD. During the rotational atherectomy-based interventional procedure, optical frequency domain imaging, a new generation of optical coherence tomography, clearly depicted lipid deposition in the culprit lesion.
phase of KD, suggesting that those post-KD patients might have a potential risk of early atherosclerosis [1, 2]. Nevertheless, few direct pathological evidences have been available for early atherosclerosis development in post-KD patients so far [3, 4]. We describe our experience with an unusual case of silent myocardial ischemia due to probable coronary sequelae of KD, in which optical frequency domain imaging (OFDI), a new generation of optical coherence tomography (OCT), could clearly delineate lipid plaque in the culprit lesion.
Keywords Optical coherence tomography Optical frequency domain imaging Intravascular ultrasound imaging Rotational atherectomy Kawasaki disease
An asymptomatic 47-year-old-male was admitted to our hospital because of calcification exclusively in the proximal segment of left anterior descending coronary artery (LAD) on chest computed tomography (CT) for medical check-up. Although he had no obvious past history of KD, he had experienced 40 days’ admission due to fever of unknown origin concomitant with systemic eruption at the age of 6 months. His coronary risk factor included dyslipidemia, and under the medication of rosuvastatin 2.5 mg/ day and fenofibrate 80 mg/day, blood test at admission showed low-density lipoprotein 136 mg/dL, high-density lipoprotein 55 mg/dL and triglyceride 167 mg/dL. Coronary CT indicated aneurysmal formation with eggshell-like severe calcification extending to the outlet of the aneurysm in the proximal LAD and suggested presence of stenosis composed of low-density plaque and calcification at the inlet of the aneurysm (Fig. 1a, b). No definite plaques were observed in the mid-distal LAD, right coronary artery (RCA) and left circumflex coronary artery (LCx). Coronary angiography revealed a severe stenosis in the proximal LAD, consistent with the coronary CT findings (Fig. 1c).
Introduction Possible risk for early atherosclerosis progression in patients with prior Kawasaki disease (KD) is now having more att
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