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Background <p>Coronary angiography (CAG) plays a critical role in the detailed anatomical assessment of coronary artery lesions (CALs) during the early recovery phase of Kawasaki disease (KD) in children. However, its practical experience and reported outcomes in pediatric populations remain limited.</p> Objective <p>To summarize the coronary angiographic features and evaluate the safety and feasibility of CAG in children with KD complicated by CALs.</p> Methods <p>We retrospectively analyzed the clinical and angiographic data of 15 consecutive children with KD complicated by CAL (KD-CAL) who underwent CAG during the recovery phase (3–6 months after disease onset) at our center between June 2020 and June 2024. Preoperative transthoracic echocardiography was performed for CAL assessment, followed by selective CAG under general anesthesia. Procedural parameters, lesion characteristics, and clinical outcomes were systematically reviewed.</p> Results <p>All 15 children (median age 1.5 years) successfully completed CAG without immediate complications. A total of 21 CALs were identified, predominantly located in the left main stem (38.1%, 8/21) and the proximal left anterior descending branch (38.1%, 8/21). Lesion distribution included small aneurysms/dilatations (47.4%), medium aneurysms (31.6%), and giant aneurysms (21.0%). CAG detected one case of coronary stenosis with collateral vessel formation and one case of intra-aneurysmal thrombosis, both missed by preoperative echocardiography. No significant differences were observed in aneurysm dimensions (inlet, widest, outlet diameters, and length) or in Z-scores between echocardiography and CAG (all <i>P</i> &gt; 0.05). Median fluoroscopy time was 3.1&#xa0;min, radiation dose-area product was 42&#xa0;Gy·cm², and contrast volume was 1.5 mL/kg. During a median follow-up of 33 months, no coronary events occurred.</p> Conclusion <p>In children with high-risk KD-CAL, invasive coronary angiography (CAG) is a safe and feasible procedure that provides superior anatomical detail for detecting critical complications such as stenosis and thrombosis. Echo-cardiography remains the first-line modality for aneurysm sizing and serial monitoring. However, for comprehensive coronary assessment following echocardiography, CT coronary angiography (CTCA) is the preferred non-invasive imaging standard. Invasive CAG should be reserved for selected high-risk or complex cases where it provides decisive anatomical and functional information to guide definitive management.</p>

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Evaluation of coronary artery lesions in children with Kawasaki disease by coronary angiography

  • 期刊论文

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  • 发表日期：

    2026年2月3日

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  • Li Chen,
  • Ting Ting Feng,
  • Du Fei Zhang

摘要

Background

Coronary angiography (CAG) plays a critical role in the detailed anatomical assessment of coronary artery lesions (CALs) during the early recovery phase of Kawasaki disease (KD) in children. However, its practical experience and reported outcomes in pediatric populations remain limited.

Objective

To summarize the coronary angiographic features and evaluate the safety and feasibility of CAG in children with KD complicated by CALs.

Methods

We retrospectively analyzed the clinical and angiographic data of 15 consecutive children with KD complicated by CAL (KD-CAL) who underwent CAG during the recovery phase (3–6 months after disease onset) at our center between June 2020 and June 2024. Preoperative transthoracic echocardiography was performed for CAL assessment, followed by selective CAG under general anesthesia. Procedural parameters, lesion characteristics, and clinical outcomes were systematically reviewed.

Results

All 15 children (median age 1.5 years) successfully completed CAG without immediate complications. A total of 21 CALs were identified, predominantly located in the left main stem (38.1%, 8/21) and the proximal left anterior descending branch (38.1%, 8/21). Lesion distribution included small aneurysms/dilatations (47.4%), medium aneurysms (31.6%), and giant aneurysms (21.0%). CAG detected one case of coronary stenosis with collateral vessel formation and one case of intra-aneurysmal thrombosis, both missed by preoperative echocardiography. No significant differences were observed in aneurysm dimensions (inlet, widest, outlet diameters, and length) or in Z-scores between echocardiography and CAG (all P > 0.05). Median fluoroscopy time was 3.1 min, radiation dose-area product was 42 Gy·cm², and contrast volume was 1.5 mL/kg. During a median follow-up of 33 months, no coronary events occurred.

Conclusion

In children with high-risk KD-CAL, invasive coronary angiography (CAG) is a safe and feasible procedure that provides superior anatomical detail for detecting critical complications such as stenosis and thrombosis. Echo-cardiography remains the first-line modality for aneurysm sizing and serial monitoring. However, for comprehensive coronary assessment following echocardiography, CT coronary angiography (CTCA) is the preferred non-invasive imaging standard. Invasive CAG should be reserved for selected high-risk or complex cases where it provides decisive anatomical and functional information to guide definitive management.