title: [An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].
abstract: Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.
authors.affiliation: Clinique cardiologique, CHU Trousseau, Tours.
authors.forename: C
authors.initials: C
authors.lastname: Mycinski
authors.forename: G
authors.initials: G
authors.lastname: Doll
authors.forename: P
authors.initials: P
authors.lastname: Lermusiaux
authors.forename: G
authors.initials: G
authors.lastname: Pacouret
authors.forename: R
authors.initials: R
authors.lastname: Lanotte
authors.forename: L
authors.initials: L
authors.lastname: Vaillant
authors.forename: B
authors.initials: B
authors.lastname: Desveaux
authors.forename: B
authors.initials: B
authors.lastname: Charbonnier
authors.forename: P
authors.initials: P
authors.lastname: Raynaud
authors.forename: M L
authors.initials: ML
authors.lastname: Brochier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001161:Arteriosclerosis / Q000150:complications* / Q000473:pathology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002784:Cholesterol; D003327:Coronary Disease; D004617:Embolism / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000209:etiology; D008875:Middle Aged; D009135:Muscular Diseases / Q000209:etiology; D011379:Prognosis; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology
chemical_list: D002784:Cholesterol
vernacular_title: Une complication souvent méconnue du cathétérisme gauche: les embolies de cristaux de cholestérol. A propos de 9 observations.