[Update on cholesterol crystal embolism].

Area of Science:

• Cardiovascular Medicine
• Pathology
• Nephrology

Background:

• Cholesterol crystal embolism (CCE) is a systemic disease linked to widespread atherosclerosis.
• It results from microemboli from atherosclerotic plaques causing arteriolar occlusion and necro-inflammation.
• CCE frequently affects the skin, kidneys, and digestive system, carrying a poor prognosis.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, diagnosis, and management of cholesterol crystal embolism.
• To highlight the diagnostic challenges and poor prognosis associated with CCE.
• To discuss current treatment strategies for CCE and its underlying causes.

Main Methods:

• Literature review of pathophysiology, clinical manifestations, and diagnostic approaches.
• Analysis of risk factors, including vascular interventions and antithrombotic therapy.
• Evaluation of current treatment modalities, including symptomatic, etiological, and supportive therapies.

Main Results:

• CCE is characterized by heterogeneous clinical presentations and multi-organ involvement.
• Vascular interventions are a key factor in embolic migration, complicating diagnosis compared to spontaneous events.
• Diagnosis relies on a combination of clinical, biological, and histological findings, often as a diagnosis of exclusion.

Conclusions:

• CCE is an underdiagnosed condition with a severe prognosis, sharing risk factors with atherosclerosis.
• Management involves addressing cardiovascular risk factors, statin therapy, and potentially interventional procedures.
• Treatment strategies are not well-codified, with ongoing debate regarding antithrombotic therapy and consideration of corticosteroids, colchicine, or LDL apheresis.