Novel Percutaneous Coronary Intervention Techniques for Revascularizing Chronically Occluded Giant Coronary Aneurysms in a Patient with Kawasaki Disease

Kawasaki disease is a self-limiting vasculitis presenting in childhood that can lead to aneurysms of the coronary arteries. Patients who develop giant coronary aneurysms have a high incidence of coronary stenoses and occlusions resulting in myocardial ischemia. The mainstay of treatment for these lesions is surgical bypass due to complex coronary anatomy and a high rate of chronic total occlusions precluding traditional percutaneous coronary intervention techniques. We report the first successful percutaneous revascularization of two chronically occluded giant coronary aneurysms using the Hybrid Interventional Strategy for approaching chronic total occlusions. Both antegrade and retrograde dissection-reentry techniques were employed to fully revascularize two major epicardial arteries. Despite procedural success, longer-term vessel patency was not maintained following stent deployment highlighting the difficulty in maintaining durable results with percutaneous coronary intervention in this patient population.