Cholesterol Embolisation after Thrombolytic Therapy

Abstract

Cholesterol embolisation has been reported in 27 patients receiving thrombolytic therapy for acute myocardial infarction (MI). Since cholesterol embolisation is so difficult to diagnose ante mortem, it is possible that these cases represent the 'tip of the iceberg', and that cholesterol embolisation in this setting is far more common than usually suspected. However, the risks of cholesterol embolisation are far outweighed by the survival benefits of thrombolytic therapy in patients with MI. Nevertheless, clinicians should maintain a high level of suspicion when clinical manifestations suggestive of cholesterol embolisation appear after thrombolytic therapy, as the risk of morbidity and mortality can be high.

Livedo reticularis: An update

“…48 Common initiating events include catheter procedures, major vessel operation, and pharmacologic therapy (thrombolytics and anticoagulants). 48,51,52 If CES is suggested in a patient, biopsy of purpuric skin has a high diagnostic yield (75%-90%), demonstrating cholesterol clefts in small arteries and arterioles. 48,53 This is important, as cutaneous findings may be the initial findings of CES.…”

Atheromatous embolization

“…70,71 If there is a valid indication for thrombolytic therapy, it should not be withheld in any patient for fear of atheromatous embolization. 72 …”

Cholesterol Embolization Syndrome After Kidney Transplantation: A Case Series and Systematic Review

“…Anticoagulant therapy is also considered a risk factor, as this treatment may lead to the disruption of aortic plaques. 3 , 5 , 6 …”

“…Anticoagulant therapy is also considered a risk factor, as this treatment may lead to the disruption of aortic plaques. 3,5,6 CES rarely occurs in kidney transplants. Little is known about its incidence, histopathology and prognosis in kidney transplant recipients.…”