Multiple cholesterol emboli syndrome--six cases identified through the spontaneous reporting system
M Hauben1, J Norwich, E Shapiro
1Medical Department, Sterling Winthrop Inc., New York, New York, USA.
Insights
Multiple cholesterol emboli syndrome (MCES) can present acutely after procedures like cardiac catheterization. Angiographers must recognize MCES in patients with multi-organ dysfunction post-catheterization.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Multiple cholesterol emboli syndrome (MCES) is a rare but serious complication.
- Risk factors include invasive vascular procedures and anticoagulation.
Observation:
- A review of adverse event reports identified six suspected MCES cases.
- Five cases presented acutely during or immediately after intra-arterial catheterization.
Findings:
- Common antecedent risk factors included cardiac catheterization and various arteriographies.
- Frequent clinical manifestations were acute renal failure, hypertension, pain, and livedo reticularis.
Implications:
- Angiographers should maintain a high index of suspicion for MCES.
- Early recognition and consideration of MCES are crucial for patients with multi-organ dysfunction post-catheterization.
Abstract:
Six cases of suspected multiple cholesterol emboli syndrome were identified by a review of reports contained in the company's records of adverse event reports. Antecedent risk factors in these reports included cardiac catheterization, thrombolytic therapy, translumbar aortography, renal arteriography, subclavian arteriography, abdominal aortography, and heparinization. Unlike the commonly reported subacute presentation, onset occurred during or immediately after catheterization in 5 of the 6 patients reported. Acute renal failure; hypertension; back, leg, and/or abdominal pain; and livedo reticularis were the events most frequently reported. Angiographers should consider multiple cholesterol embolization when multiple organ system dysfunction occurs during or immediately after intraarterial catheterization.
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