Kawasaki disease primarily affects children under 5 years of age. Lesions primarily involve generalized inflammation of small and medium-sized vessels. Structural and functional changes in the coronary arteries make this disease the most common coronary artery disease in children. The disease involves destruction of the vascular endothelium, leading to remodeling and the formation of aneurysms, among other conditions. We are learning more and more about the factors causing this damage. Currently, inflammatory mediators, immune cells, and oxidative stress are involved in the pathogenesis of endothelial destruction. Pyroptosis, leading to the death of vascular endothelial cells, also appears to be important. Numerous genetic changes promoting these changes in non-coding miRNA sequences have also been described. There is a noticeable connection between changes occurring in the coronary vessels and subsequent cardiovascular incidents, especially when diseases such as hypercholesterolemia, diabetes and atherosclerosis occur. Because the disease was first described in 1967, data on its long-term effects are still being collected.