Cholesterol Embolization Syndrome After Carotid Artery Stenting Associated with Delayed Cerebral Hyperperfusion
Awadh Kishor Pandit1, Tomotaka Ohshima2, Reo Kawaguchi3
1Department of Neurology, All India Institute of Medical Sciences, Delhi, India.
Insights
Cholesterol embolization syndrome (CES) can cause multiorgan damage after procedures like carotid artery stenting. Early detection and treatment of CES are crucial for reducing patient mortality and morbidity.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Neurology
Background:
- Cholesterol embolization syndrome (CES) arises from cholesterol crystal emboli from atheromatous plaques, leading to widespread organ damage.
- CES is a serious complication following interventions on large vessels, particularly the aorta.
Background:
The cholesterol embolization syndrome (CES) results from the distal embolization of cholesterol crystals from atheromatous plaques in large vessels such as the aorta and results in multiorgan damage.
Case Description:
We present the case of a patient with definite CES with skin manifestations (e.g., blue toes) and renal and neurological dysfunction, including parenchymal hematoma with cytotoxic and vasogenic edema after he had undergone left carotid artery stenting for symptomatic critical left carotid artery stenosis.
Conclusions:
Our patient with CES had cutaneous involvement affecting the lower limbs and renal and neurological involvement. High clinical suspicion and early treatment can reduce the mortality and morbidity after endovascular procedures. The neurological symptoms had most likely resulted from delayed cerebral hyperperfusion syndrome resulting in intracerebral hemorrhage.
