Cholesterol Crystal Embolism Following Mechanical Thrombectomy for Acute Ischemic Stroke

Abstract

Cholesterol crystal embolism (CCE) is a rare but serious complication of atherosclerotic plaque rupture, often occurring after endovascular interventions. We report the case of a 73-year-old man who developed CCE following mechanical thrombectomy (MT) for an acute ischemic stroke (AIS) due to left internal carotid artery occlusion. The patient, with a history of hypertension and hyperlipidemia, underwent successful MT with complete recanalization. However, four weeks after the procedure, he presented with blue toe syndrome and acute kidney injury. Histopathological analysis of a skin biopsy confirmed the diagnosis of CCE. The patient’s renal function partially improved with corticosteroid therapy. Clinicians should maintain a high level of suspicion for CCE in patients who develop renal dysfunction or peripheral ischemia after MT, particularly in those with significant atherosclerotic risk factors. Early detection and timely intervention are critical for improving outcomes. Further research is warranted to clarify the incidence and optimal management of CCE in the context of MT for AIS.