Salvage stent implantation for anastomotic stenosis after coronary artery bypass grafting in Kawasaki disease: a case report

Abstract Giant coronary artery aneurysms (CAAs) secondary to Kawasaki disease (KD) carry a poor prognosis, mainly due to the risk of severe stenosis and myocardial infarction. While revascularization options including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are available for severe coronary complications, reports on managing post-CABG anastomotic stenosis in children are limited. We present a 12-year-old boy who, after multi-vessel CABG for occlusive KD-related coronary lesions, developed stenosis of the right internal mammary artery (RIMA)–right coronary artery (RCA) graft one year after CABG; the stenosis was successfully treated with stent implantation. This case illustrates the clinical complexity and need for multidisciplinary care in KD-related giant CAAs, highlights the importance of continued surveillance for delayed complications, and shows that PCI can be an effective therapeutic option for selected cases. Our experience may help guide individualized management in this high-risk pediatric population.