Cholesterol embolism

Instrumental procedures in coronary arteries or the aorta may dislodge valvular or atheromatous debris causing neurological complications (Ayas and Wijdicks 1995) and cholesterol embolization. 

Cross SS (1991). How common is cholesterol embolism Journal of Clinical Pathology 44 859-861... 

Cholesterol embolization, which promptly improves after the drug is withdrawn (24), may explain the purple-toe phenomenon. 

In one case, multisystem abnormalities, including renal insufficiency, were caused by cholesterol embolization. Withdrawal of the anticoagulant resulted in dramatically improved renal function (24). 

Harrington D, Amplatz K. Cholesterol embolization and spinal infarction following aortic catheterization. Am J Roentgenol Radium Ther Nucl Med I972 II5(I) I7I. ... 

Embolic detachment of components of venous or mural thrombi can sometimes be involved in the development of thromboembolism or cholesterol embolization. There is a 10% incidence of pulmonary embolism during thrombolysis, lethal in 0-5% (5), pointing to the risk of detachment of white components of venous thrombi, especially if large veins, such as those in the pelvis, are involved (6). However, the risk has not been proven to exceed that reported in patients treated with heparin and/or oral anticoagulants. 

Cholesterol embolization is thought to occur after removal of mural thrombi covering atherosclerotic plaques leading to direct exposure of the soft lipid-laden core of these plaques to the arterial circulation. The contents of the soft lipid core, including crystallized cholesterol, shower the downstream circulation. Cholesterol crystals are impervious to dissolution or lysis and they lodge in small arterioles, causing obstruction. Cholesterol embolization shortly after thrombolytic treatment is characterized by livedo reticularis or multiple necrotic lesions of the skin of both legs (7) but can also be associated with... 

Acute interstitial nephritis associated with cholesterol embolization during streptokinase therapy has been reported (47). In this case, cholesterol clefts were found in the preglomerular and interlobular arterioles. 

Cholesterol embolization can cause acute renal insufficiency (9), and renal biopsy shows acute tubular necrosis with, in some instances, arteriolar clefts representing cholesterol crystals (10). 

Queen M, Biem HJ, Moe GW, Sugar L. Development of cholesterol embolization syndrome after intravenous streptokinase for acute myocardial infarction. Am J Cardiol 1990 65(15) 1042-3. 

Adorati M, Pizzolitto S, Franzon R, Vallone C, Artero M, Moro A. Cholesterol embolism and acute interstitial nephritis two adverse effects of streptokinase thrombolytic therapy in the same patient. Nephrol Dial Transplant 1998 13(5) 1262-4. 

Lye WC, Cheah JS, Sinniah R. Renal cholesterol embolic disease. Case report and review of the literature. Am J Nephrol 1993 13 489-493. 

Laloux P Steroid-responsive leucoencephalopathy due to cholesterol embolism. J Neurol Neurosurg Psychiatr 2007 78 p. 112. 

Tenecteplase Tissue plasminogen activator Acute myocardial infarction Bleeding, arrhythmias, cholesterol embolization... 

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