[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases]

Arch Mal Coeur Vaiss. 1990 Oct;83(11):1643-50.
[Article in French]

Abstract

Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.

Publication types

  • Case Reports
  • English Abstract
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / adverse effects
  • Arteriosclerosis / complications*
  • Arteriosclerosis / pathology
  • Cardiac Catheterization / adverse effects*
  • Cholesterol*
  • Coronary Disease
  • Embolism / etiology*
  • Embolism / pathology
  • Embolism / therapy
  • Female
  • Humans
  • Intracranial Embolism and Thrombosis / etiology
  • Kidney Diseases / etiology
  • Male
  • Mesenteric Vascular Occlusion / etiology
  • Middle Aged
  • Muscular Diseases / etiology
  • Prognosis
  • Skin Diseases / etiology
  • Skin Diseases / pathology

Substances

  • Cholesterol