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Open Access Publications from the University of California

Assessment of Coronary Artery Aneurysms Cased By Kawasaki Diesease Using Transluminal Attenuation Gradient Analysis of CT Angiograms

  • Author(s): Gutierrez, Noelia Grande
  • Advisor(s): Marsden, Alison L
  • et al.

Patients with coronary artery aneurysms (CAA) resulting from Kawasaki Disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend using CAA diameter >8 mm as the criterion for initiating systemic anticoagulation, but there is little outcome data to support this choice. Transluminal Attenuation Gradient (TAG) has been proposed as a non-invasive method for evaluating the functional significance of coronary stenoses using CT Angiography (CTA). However TAG has not previously been used to assess CAA. We hypothesized that abnormal flow dynamics in CAA caused by KD could be quantified using TAG. We quantified TAG in the major coronary arteries by performing linear regression of the average lumen intensity as a function of vessel length and compared TAG values for aneurysmal and normal arteries. Aneurysm geometry was characterized using maximum aneurysm diameter, aneurysm shape index and sphericity index. TAG of aneurysmal arteries was significantly lower than in normal arteries. Significant differences were also seen between aneurysmal vs. normal left anterior descending and right coronary. Geometrical parameters showed minimal to no correlation with TAG. This study is the first application of TAG analysis to CAA caused by KD, and demonstrates significantly different TAG values in aneurysmal versus normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide information on hemodynamic conditions not available from anatomy alone. The use of TAG in KD patients represents a possible extension to standard CTA that could aid in clinical decision-making and help to better evaluate the risk of thrombus formation.

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