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Published on: June 29, 2015
Cholesterol embolization syndrome induced by thrombolytic therapy
Wassim A Hitti1, Ravinder K Wali, Edward J Weinman
1Department of Medicine, University of Maryland Medical System, Baltimore, Maryland, USA. wassimhitti@yahoo.com
Summary
Cholesterol embolization syndrome (CES) after thrombolytic therapy is rare but serious. Early diagnosis is key, as outcomes are often poor despite supportive care, highlighting the need for vigilance after such treatments.
Area of Science:
- Cardiology
- Nephrology
- Dermatology
Background:
- Cholesterol embolization syndrome (CES) is a rare complication of thrombolytic therapy.
- It carries a high morbidity and mortality rate.
- Varied clinical presentations can delay diagnosis.
Purpose of the Study:
- To review published case reports of CES induced by thrombolytic therapy.
- To identify common presentations, outcomes, and diagnostic challenges.
- To inform clinical suspicion and management strategies.
Main Methods:
- Comprehensive literature review of English-language case reports from January 1980 to December 2007.
- Searched multiple electronic databases and hand-searched reference lists.
- Identified 30 cases of thrombolytic-induced CES.
Main Results:
- Most cases (28/30) involved thrombolysis for acute myocardial infarction.
- Common presentations included skin manifestations (livedo reticularis, rash) and renal involvement.
- Significant morbidity observed: chronic hemodialysis (8 patients), amputations (4), CKD progression (7), and 7 deaths.
Conclusions:
- CES presents as multiorgan dysfunction and should be considered post-thrombolysis.
- Diagnosis is challenging due to variable symptoms; biopsy is confirmatory.
- Management is supportive, recurrence prevention is crucial, and outcomes remain poor.
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