Cholesterol Atheroembolism Syndrome: Current State of the Problem
https://doi.org/10.20514/2226-6704-2020-10-4-272-280
Abstract
Cholesterol atheroembolism syndrome is a systemic pathological process caused by the embolization of small arteries with cholesterol crystals, which can develop spontaneously, and it is the result of intravascular surgery and / or the use of anticoagulants. Embolization cholesterol crystals leads to ischemic and inflammatory organ damage. The clinical picture is variable, various organs can be targets, but skin and kidneys are mainly affected. Specific clinical and laboratory signs aren’t. Tissue biopsy is the gold standard for diagnosis cholesterol atheroembolism syndrome. The treatment is based on the correction of classical cardiovascular risk factors, the use of statins. In terms of benefit and risk failure from anticoagulants and thrombolytics should be considered. Studies on the use of corticosteroids, cytostatic, and colchicine have conflicting results. The use of monoclonal antibodies of IL-1 antagonists is a perspective direction.
About the Authors
z. D. Mikhailova
Municipal Clinical hospital № 38
Russian Federation
N. Novgorod
Russian Federation
N. Novgorod
P. F. Klimkin
Municipal Clinical hospital № 5
Russian Federation
N. Novgorod
Russian Federation
N. Novgorod
References
1. Smirnov A.V., Dobronravov V.A., Rumjancev A.Sh. et al. Acute kidney injury. M., OOO «Izdatel’stvo «Medicinskoe informacionnoe agentstvo». 2015; 488 s. ISBN 978-5-9986-0228-3 [In Russian].
2. Ozkok A. Cholesterol-embolization syndrome: current perspectives. Vasc Health Risk Manag. 2019; 15: 209-20. doi: 10.2147.
3. Denis Le Seve J., Gourraud Vercel C., Connault J. et al. Update on cholesterol crystal embolism. Rev Med Interne. 2020;41(4):250-7. doi: 10.1016/j.revmed.
4. Hickey T.B., Honig A., Ostry A.J. et al. Iatrogenic embolization following cardiac intervention: postmortem analysis of 110 cases. Cardiovasc. Pathol. 2019; 40: 12-8. doi: 10.1016/j. carpath.2019.01.003.
5. Agrawal A., Ziccardi M.R., Witzke C. et al. Cholesterol embolization syndrome: An under-recognized entity in cardiovascular interventions. J Interv Cardiol. 2018; 31(3): 407-15. doi: 10.1111/joic.12483.
6. Higo S., Hirama A., Ueda K. et al. A patient with idiopathic cholesterol crystal embolization: effectiveness of early detection and treatment. J Nippon Med Sch. 2011; 78(4): 252-6. doi: 10.1272 / jnms.78.252.
7. Frank R.D. Cholesterol embolism syndrome: a rare, but severe complication in patients with atherosclerosis. Dtsch Med Wochenschr. 2012; 137(21): 1130-4. doi: 10.1055/s-0032-1305005.
8. Fukumoto Y, Tsutsui H, Tsuchihashi M. et al. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. 2003; 42:211. doi:10.1016/S0735-1097(03)00579-5.
9. Konstantinou D.M., Chatzizisis Y.S., Farmakis G. et al. Cholesterol embolization syndrome following thrombolysis during acute myocardial infarction. Herz. 2012; 37(2): 231-3. doi: 10.1007/s00059011-3442-7.
10. Scolari F., Ravani P. Atheroembolic renal disease. Lancet. 2010; 375(9726): 1650. doi:10.1016/S0140-6736(09)62073-0.
11. Fujikawa S., Iguchi R., Noguchi T. et al. Cholesterol crystal embolization following urinary diversion: a case report. Hinyokika Kiyo. 2015; 61(3): 99-102.
12. Editorial of the journal «Clinical Nephrology». Cholesterol atheroembolic disease — emerging variant of acute kidney injury. Klinicheskaja nefrologija. 2011; (3): 4-10. ISSN: 2075-3594 [In Russian].
13. Igarashi Y., Akimoto T., Kobayashi T. et al. Performing Anticoagulation: A Puzzling Case of Cholesterol Embolization Syndrome. Clin Med Insights Case Rep. 2017; 10: 1179547616684649. doi: 10.1177/1179547616684649.
14. Kim H., Zhen D.B., Lieske J.C. et al. Treatment of Cholesterol Embolization Syndrome in the Setting of an Acute Indication for Anticoagulation Therapy. J Med Cases. 2014; 5(6): 376-9. doi: 10.14740/jmc1804w.
15. Piorkowski M., Kläffling C., Botsios S. et al. Postinterventional microembolism signals detected by transcranial Doppler ultrasound after carotid artery stenting. Vasa. 2015; 44(1): 49-57. doi: 10.1024/0301-1526/a000406.
16. Imai N., Zamami R., Kimura K. Cutaneous cholesterolembolization syndrome. Indian J Dermatol Venereol Leprol. 2015; 81(4): 388. doi: 10.4103/0378-6323.158664.
17. Vuurmans T., Byrne J., Fretz E. et al. Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia Cardiac and Renal Registries). Heart. 2010; 96(19): 1538– 1542. doi:10.1136/hrt.2009.192294.
18. Kooiman J., Seth M., Dixon S. et al. Risk of acute kidney injury after percutaneous Coronary interventions using radial versus femoral access. insights from the blue cross blue shield of Michigan cardiovascular consortium. Circ Cardiovasc Interv. 2014; 7: 190–8. doi:10.1161/circinterventions.113.000778.
19. Ando G., Cortese B., Russo F. et al. Acute kidney injury after radial or femoral access for invasive acute Coronary syndrome management, AKI-MATRIX. J Am Coll Cardiol. 2017; 69: 2592–603. doi:10.1016/j. jacc.2016.11.026.
20. Ghanem F., Vodnala D., K Kalavakunta J. et al. Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features. J Biomed Res. 2017; 31(2): 82-94. doi: 10.7555/ JBR.31.20160100.
21. Grebe A., Latz E. Cholesterol crystals and inflammation. Curr Rheumatol Rep. 2013; 15(3): 313. doi: 10.1007/s11926-012-0313-z.
22. Saric M., Kronzon I. Cholesterolembolization syndrome. Curr Opin Cardiol. 2011; 26(6): 472-9. doi: 10.1097/HCO.0b013e32834b7fdd.
23. Kumakura S., Nakamichi T., Suzuki N. et al. A Catastrophic Case of Idiopathic Cholesterol Crystal Embolism with Multiple Lethal Complications: A Labyrinth Underneath the Diagnosis of Skin Ulcers in Chronic Kidney Disease Patients. Intern Med. 2019; 58(12): 1753-8. doi: 10.2169/internalmedicine.2378-18.
24. Zaveri S., Price L.Z., Tupper H. et al. Atheroembolism to the Breast. Ann Vasc Surg. 2020; 64: 411.e17-411.e20. doi: 10.1016/j. avsg.2019.10.052.
25. Patro N., George R., Singh P. et al. Cutaneous cholesterolembolization syndrome: A case report. Dermatol Online J. 2012; 18(7): 10. PMID: 22863632.
26. Dizman N., Aydın Bahat K., Özkanl S. et al. Cholesterol embolization syndrome: A report of two cases. Turk Kardiyol Dern Ars. 2016; 44(3): 251-5. doi: 10.5543/tkda.2015.94587.
27. Li X., Bayliss G., Zhuang S. Cholesterol Crystal Embolism and Chronic Kidney Disease. Int J Mol Sci. 2017; 18(6). pii: E1120. doi: 10.3390/ ijms18061120.
28. Jansi Prema K.S., Kurien A.A. Atheroembolic Renal Disease: A Case Series. Indian J Nephrol. 2019; 29(6): 427-30. doi: 10.4103/ijn. IJN_265_18.
29. González A.P., Juega J., Vazquez C. et al. Late Onset of Cholesterol Embolism Leading to Graft Failure After Renal Transplantation: Report of Two Cases. Transplant Proc. 2015; 47(8): 2361-3. doi: 10.1016/j. transproceed.2015.09.005.
30. Corradetti V., Comai G., Ravaioli M. et al. Iloprost in Acute Postkidney Transplant Atheroembolism: A Case Report of Two Successful Treatments. 2020; 7: 41. doi: 10.3389/fmed.2020.00041.
31. Hajimaghsoudi M., Zeinali F., Mansouri M. et al. Acute necrotizing pancreatitis following coronary artery angiography: A case report. ARYA Atheroscler. 2017; 13(3): 156-8. PMCID: PMC5677330.
32. Matsui K., Mochida Y., Ishioka K. et al. A case of enteric peritonitis in a patient with stage 5 kidney disease due to cholesterol crystal embolization. Perit Dial Int. 2020; 40(2): 220-1. doi: 10.1177/0896860819887293.
33. Moriya M., Naba I., Nakano M. et al. A case of cholesterol embolization syndrome with cognitive impairment and pulmonary hemorrhage. Rinsho Shinkeigaku. 2015; 55(11): 823-7. doi: 10.5692/ clinicalneurol.cn-000723.
34. Il’ina S.N., Krinec Zh.M., Solodovnikova I.G. Changes in the visual organ in General diseases. Grodno, GrGMU. 2016; 171 p. [In Russian].
35. Kalinin R.E., Suchkov I.A., Abrosinov V.N. Ischemic diseases in the practice of a family doctor. M., GJeOTAR-Media. 2016; 208 р. ISBN 978-5-9704-3660-8 [In Russian].
36. Dunlap AB, Kosmorsky GS, Kashyap VS. The fate of patients with retinal artery occlusion and Hollenhorst plaque. J V asc Surg. 2007; 46(6):1125-1129. doi:10.1016/j.jvs.2007.07.054.
37. Kitamura N., Sasabe E., Kitaoka H. et al. Unilateral necrosis of the tongue caused by embolisation of cholesterol crystals. Br J Oral Maxillofac Surg. 2018; 56(4): 340-2. doi: 10.1016/j. bjoms.2018.03.003.
38. Bogdanov A.N., Voloshin S.V., Kulibaba T.G. et al. Changes in the blood system in clinical practice SPB, Foliant. 2017; 172 p. ISBN: 978-593929-277-1 [In Russian].
39. Cardiovascular prevention 2017. National guidelines. Russ J Cardiol. 2018; 23(6): 7–122. http://dx.doi.org/10.15829/1560-4071-2018-6-7122 [In Russian].
40. Kusakari Y., Yamasaki K., Aiba S. Painful macules of hand cholesterol crystal embolization successfully treated with oral corticosteroid, statin, and sarpogrelate. J Dermatol. 2014; 41(7): 662-4. doi: 10.1111/1346-8138.12530.
41. Nakayama M., Izumaru K., Nagata M. et al. The effect of low-dose corticosteroids on short- and long-term renal outcome in patients with cholesterol crystal embolism. Ren. Fail. 2011; 33(3): 298–306. doi: 10.3109 / 0886022X. 2011.560403.
42. Desai M., Ram R., Prayaga A. et al. Cholesterol crystal embolization (CCE): improvement of renal function with high-dose corticosteroid treatment. Saudi J Kidney Dis Transpl. 2011; 22: 327-30. PMID: 21422636.
43. Beuy J., Wiwanitkit V. Cholesterol embolization syndrom. Turk Kardiyol Dern Ars. 2016; 44(6): 537-8. doi: 10.5543/tkda.2016.65623.
44. Martínez G.J., Celermajer D.S., Patel S. The NLRP3 inflammasome and the emerging role of colchicine to inhibit atherosclerosis-associated inflammation. Atherosclerosis. 2018; 269: 262-271. doi:10.1016/j. atherosclerosis.2017.12.027.
45. Nidorf S.M., Eikelboom J.W., Thompson P.L. Targeting cholesterol crystal-induced inflammation for the secondary prevention of cardiovascular disease. J Cardiovasc Pharmacol Ther. 2014; 19(1): 45-52. doi:10.1177/1074248413499972.
46. Verneuil L., Ze Bekolo R., Dompmartin A. et al. Efficiency of colchicine and corticosteroids in a leg ulceration with cholesterol embolism in a woman with rheumatoid arthritis. Rheumatology (Oxford). 2003; 42(8): 1014-6. doi:10.1093/rheumatology/keg252.
47. Ridker P.M., Everett B.M., Thuren T. et al. CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017; 377(12): 1119-31. doi: 10.1056 / NEJMoa1707914.
48. Ishiyama K., Sato T., Taguma Y. Low-density lipoprotein apheresis ameliorates renal prognosis of cholesterol crystal embolism. Ther Apheresis Dial. 2015; 19: 355-60. doi:10.1111/17449987.12345.
49. Kim M.G., Kim S.J., Oh J. et al. Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization. Kidney Res Clin Pract. 2013; 32(4): 186-9. doi: 10.1016/j.krcp.2013.08.004.
Review
For citations:
Mikhailova z.D., Klimkin P.F. Cholesterol Atheroembolism Syndrome: Current State of the Problem. The Russian Archives of Internal Medicine. 2020;10(4):272-280. https://doi.org/10.20514/2226-6704-2020-10-4-272-280
Views:
1436
Email this article 