| Primary goal | Focal dilatation/lesion preparation (including cutting/scoring) | Scaffold + drug release to suppress restenosis | Modify/ablate calcium to enable delivery/expansion | Fracture deep/circumferential calcium to facilitate stent expansion/delivery |
| Advantages in KD | No implant → preserves growth/future surgery | Immediate lumen gain; restenosis suppression | Enables adequate stent expansion in heavy calcification | Lower risk of distal embolization/slow flow compared to RA; effective for deep calcium fracture |
| Main limitations | Elastic recoil/dissection; higher mid-term restenosis in calcific/aneurysm-adjacent segments | Malapposition risk across ectatic/aneurysmal transitions; DAPT required | Slow-flow/microembolization; perforation; caution near aneurysm neck | Requires balloon access; limited data in pediatric KD |
| Indication | Very focal, non-calcific stenosis or preparation | Straight, focal lesions with good landing zones; IVUS/OCT-guided optimization | IVUS/OCT shows arc > 180°/length > 5 mm or predicted under-expansion | Severe, deep, or nodular calcification; when RA is not feasible or carries high risk |
| Antithrombotics | Usually aspirin alone (context-dependent) | DAPT 6–12 months (shorter if HBR); minimize triple therapy if OAC needed | Per final device (eg. DES, typically requiring DAPT) | Per final device (often DES → DAPT) |
| Evidence notes | Case series/registries | Adult CAD adapted to KD; imaging optimization decisive | Small KD series: event-free survival ≈ 79% at 10 y; ≈ 39% at 20 y | Emerging data; primarily adult CAD adapted; case reports in refractory KD lesions |