Treatment of cholesterol crystal embolisation syndrome with filter-assisted stenting

A 70-year-old man with acutely painful fingertips on the left hand, with ulceration and necrosis of the second and fourth fingertip, was referred to our centre for evaluation. Crystal cholesterol embolisation (CCE) from the left subclavian artery plaque was suspected on the basis on a normal brachial pulse. A selective arteriography confirmed the presence of mild (60%) subclavian stenosis and suggested the need for filter-assisted stenting of the subclavian artery to prevent CCE. The vessel was hooked with a right coronary curve 8-Fr guiding catheter and the lesion crossed with an Angioguard filter (Cordis, J&J Medical, Warren, New York, USA), 8 mm in diameter, open distally to the stenosis. A 6 mm x 18 mm balloon expandable Genesis stent (Cordis, J&J Medical, Miami Lakes, Florida, USA) was successfully deployed at a pressure of 12 atm, with good angiographic result. Macroscopic lipidic material was visible in the filter after retrieval and microscopic analysis confirmed the presence of cholesterol crystals. The patient was symptom-free with healing of the fingertips on follow-up, suggesting that CCE may be safely and effectively treated with filter-assisted angioplasty.