Dense Concentric Calcification in Kawasaki Disease With Early Graft Failure Successfully Treated With Rotatripsy-Assisted Angioplasty

BACKGROUND: The treatment of Kawasaki disease-related coronary artery disease (CAD) can be challenging due to long-standing medial calcification and aneurysmal remodeling. CASE SUMMARY: We present a case of a 32-year-old man with Kawasaki disease-related CAD, initially treated with coronary artery bypass graft surgery. The patient experienced early graft failure and presented with recurrent angina 13 months after his surgery. Repeat angiography revealed an occluded saphenous vein graft to the calcific right coronary artery. The right coronary artery was successfully treated with imaging-guided percutaneous coronary intervention using rotational atherectomy and intravascular lithotripsy. DISCUSSION: This case underscores the value of tailored calcium modification and intracoronary imaging in managing Kawasaki disease-related CAD, especially in native vessels after graft failure. TAKE-HOME MESSAGES: Kawasaki disease-related CAD presents a clinical challenge in selecting the optimal revascularization strategy. Calcium modification and intracoronary imaging are crucial for a successful percutaneous coronary intervention in Kawasaki disease-related CAD.