Fatal cerebral atheromatous embolization after cardiopulmonary bypass

Cholesterol embolization to the abdominal viscera is common. Fatal cholesterol embolization to the central nervous system is rare. This report describes a 55-year-old woman with severe atherosclerotic disease who underwent cardiac surgery during which she suffered a fatal cerebrovascular accident. Postmortem examination revealed multiple infarcts in the brain, eye, and spleen due to emboli of cholesterol crystals and other atheromatous debris from a ruptured atherosclerotic plaque in the ascending aorta at the site of an aortotomy for cardiopulmonary bypass. In patients known to have severe atherosclerotic disease, atheromatous embolization to the central nervous system should be regarded as a potential complication of surgical manipulation and incision of the aorta for cardiopulmonary bypass. Ophthalmoscopic examination may be of diagnostic value in such cases.