Cholesterol emboli syndrome
Cholesterol emboli syndrome
Description, Causes and Risk Factors:
Embolism of lipid debris from an ulcerated atheromatous deposit, generally from a large artery to small arterial branches; it is usually small and rarely causes infarction.
Cholesterol emboli syndrome is a systemic atheroembolism of cholesterol which can involve brain, eyes, kidneys, and extremities. It is commonly caused by distal showering of cholesterol crystals from aortic atheromatous plaques. Cholesterol emboli syndrome is a complication of intravascular procedures with a reported incidence of 0.6% - 0.9%.
Cholesterol emboli syndrome is due to dislodgement of atheromatic debris and emboli formation from ruptured atherosclerotic plaques lining the walls of the aorta and the major arteries. It may occur spontaneously but often follows coronary angiography and angioplasty (0.08%). Due to the crystal morphology, occlusion of the vessels is not always complete, giving rise to ischemic atrophy rather than necrosis. Subsequently, a "foreign body" type response occurs, with intima hypertrophy, giant cell sequestration and further luminal stenosis. This mechanism is responsible for the characteristic gradual decline of renal function, which develops over a period of 3 to 8 weeks.
Risk factors are old age, peripheral vascular disease (PVD), severe atherosclerosis of the ascending aorta and repeated invasive procedures.
In conclusion, the incidence of cholesterol emboli syndrome seems to be increasing following the widespread growth in the practice of invasive Cardiology. Accordingly, patients prone to developing this devastating clinical syndrome should be managed with extreme attention in order to make the diagnosis promptly and to begin supportive treatment as soon as possible.
Symptoms are often nonspecific and include,
Discoloration of skin.
Past history, clinical examination, blood tests (renal failure, leukocytosis with eosinophilia) led to diagnosis of cholesterol emboli syndrome. The diagnosis can be confirmed by biopsy of theskin, muscle or kidney, which demonstrates the characteristic appearance of cholesterol crystal clefts,with giant cell perforation into the arteriole lumen. Occasionally, the crystals can be seenas emboli in the retinal microcirculation in patientswith ischemic stroke.
Treatment options are limited. In recent years, a conservative approach with the avoidance of any further vascular intervention due to the potent embolism recurrence has been considered the best option. In the case of kidney failure, dialysis may be used to help the failing kidneys.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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