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[Cholesterol embolism after percutaneous transluminal coronary angioplasty procedure: a case report]
T Sakamoto1, N Inoue, K Kunitomo
1Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto.
Insights
Cholesterol embolism is a rare complication following cardiac procedures like angioplasty. This case highlights its delayed diagnosis and fatal outcome, emphasizing the need for awareness.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pathology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) with stent implantation is a common intervention for angina pectoris.
- Femoral artery access is frequently used for coronary angiography and interventional procedures.
Observation:
- A 68-year-old male developed renal dysfunction and purpura on his feet approximately one month after PTCA.
- Symptoms progressed to severe renal failure, leading to hospitalization and death from multiple organ failure two months later.
- Autopsy confirmed cholesterol embolism as the cause of multi-organ failure.
Findings:
- Cholesterol embolism is a rare but serious complication of angiographic and interventional procedures.
- Clinical diagnosis of cholesterol embolism can be challenging, often presenting with delayed symptoms.
- Crystal emboli were identified in multiple organs during post-mortem examination.
Implications:
- Increased frequency of interventional cardiology procedures may lead to a rise in cholesterol embolism cases.
- Early recognition and diagnosis of cholesterol embolism are crucial for potential management, despite the lack of established therapies.
- Further research into diagnostic markers and therapeutic strategies for cholesterol embolism is warranted.
Abstract:
A 68-year-old man with chest pain was treated under a diagnosis of angina pectoris based on coronary angiography by percutaneous transluminal coronary angioplasty including stent implantation performed by the femoral approach. About 1 month after intervention, his renal function deteriorated and purpura appeared on both feet, especially at the toe tips. He was treated under a tentative diagnosis of cholesterol embolism conservatively at the out-patient clinic. However, he was admitted by ambulance due to worsening renal failure 2 months later and died from multiple organ failure 2 weeks after admission. Autopsy examination identified cholesterol embolism due to crystal emboli in several organs. Cholesterol embolism rarely occurs after angiographic or interventional procedures, but is difficult to diagnose clinically and there is no established therapy. The number of intervention and angiography procedures is increasing, so the occurrence of embolism as a complication of these procedures might also increase.