Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Fifty years have passed since the first report of Kawasaki disease in 1967, and the prevalence of acute coronary syndrome in Kawasaki disease patients with coronary artery lesions exceeding 40 years old has increased. Primary coronary stent implantation is currently an acceptable method in ischaemic coronary heart disease in adults. However, it is unknown whether the stent implantation is effective or not in this population. As the clue to answer this question, I reviewed the references on Kawasaki disease patients who underwent the stent implantations between 1997 and 2019. Thirty-three patients underwent stent implantations for 34 coronary arteries. Adverse effects in the late period were found in 19 (68%) of 28 vessels with follow-up angiograms. There were complete occlusion 9, restenosis 8, and migration 2. A new aneurysm formation was found in 7 (37%) among the 19 vessels, and 6 (86%) of the 7 vessels were drug-eluting stent and 5 were found after the procedure for chronic total occlusion. The adverse effects free-rate at 1 year and 3 years were 57 and 25%, respectively. At present, the usefulness of stent implantation in the long-term results was scarce. Even if primary percutaneous coronary intervention without a stent implantation is performed for acute coronary syndrome, it can be expected to maintain the patency of the culprit lesion for several years. It is better to avoid a stent implantation as long as possible in this population. Knowing the long-term efficacy and complications of stent implantations is important for deciding the procedure.