[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].
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.
Mycinski
C
C
Clinique cardiologique, CHU Trousseau, Tours.
Doll
G
G
Lermusiaux
P
P
Pacouret
G
G
Lanotte
R
R
Vaillant
L
L
Desveaux
B
B
Charbonnier
B
B
Raynaud
P
P
Brochier
M L
ML
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
D002784:Cholesterol
Une complication souvent méconnue du cathétérisme gauche: les embolies de cristaux de cholestérol. A propos de 9 observations.