The Impact of Circulating Cholesterol Crystals on Vasomotor Function

Gadeela, Nitesh; Rubinstein, Jack; Tamhane, Umesh; Huang, Rao; Pathak, Dorothy R.; Hosein, Hazel Ann A; Rich, Michael J.; Dhar, Gaurav; Abela, George S.

doi:10.1016/j.jcin.2011.02.010

Cited by 35 publications

(12 citation statements)

References 37 publications

(36 reference statements)

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“…Compromise of the fibrous cap that separates the core form the arterial lumen leads to thrombosis with potential arterial lumen obstruction or distal embolization, causing ischemia and/or infarction. Furthermore, crystals showering into the distal artery can injure the intimal surface causing arterial spasm that further aggravates ischemia [14]. …”

Section: Atherosclerotic Carotid Artery Plaquementioning

confidence: 99%

Symptomatic and asymptomatic carotid artery plaque

Mughal

Khan²,

DeMarco

et al. 2011

Expert Review of Cardiovascular Therapy

154

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Carotid atherosclerotic plaques represent both stable and unstable atheromatous lesions. Atherosclerotic plaques that are prone to rupture owing to their intrinsic composition such as a large lipid core, thin fibrous cap and intraplaque hemorrhage are associated with subsequent thromboembolic ischemic events. At least 15–20% of all ischemic strokes are attributable to carotid artery atherosclerosis. Characterization of plaques may enhance the understanding of natural history and ultimately the treatment of atherosclerotic disease. MRI of carotid plaque and embolic signals during transcranial Doppler have identified features beyond luminal stenosis that are predictive of future transient ischemic attacks and stroke. The value of specific therapies to prevent stroke in symptomatic and asymptomatic patients with severe carotid artery stenosis are the subject of current research and analysis of recently published clinical trials that are discussed in this article.

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Section: Atherosclerotic Carotid Artery Plaquementioning

confidence: 99%

Symptomatic and asymptomatic carotid artery plaque

Mughal

Khan²,

DeMarco

et al. 2011

Expert Review of Cardiovascular Therapy

154

View full text Add to dashboard Cite

show abstract

“…3 ) [ 32 ] . Moreover, this effect was due to the scraping of the intimal surface of the artery by sharp CCs traveling downstream.…”

Section: Pathogenesismentioning

confidence: 99%

“…Transcranial Doppler (TCD) has been shown to detect particulates ejected from ruptured carotid plaques [ 43 ] . Moreover, simultaneous TCD and carotid ultrasound may provide additional insights into potentially unstable plaques [ 32 ] . …”

Section: Diagnosismentioning

confidence: 99%

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

et al. 2017

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Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.

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“…Microembolisation refers to embolised debris with a diameter below 100 μ m. Platelet-platelets aggregates, neutrophils-platelets aggregates, monocytes-platelets aggregates [13], microthrombi [14], amorphous material [15], microparticles [16], cholesterol crystals [17], and leukocytes contribute to microemboli composition [18]. Most of the embolised material is classified as microembolisation [19].…”

Section: Distal Embolisation Definition and Pathophysiologymentioning

confidence: 99%

Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention

et al. 2013

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The detachment of atherothrombotic material from the atherosclerotic coronary plaque and downstream embolisation is an underrecognized phenomenon and it causes different degrees of impairment of the coronary microcirculation. During treatment of obstructive atherosclerotic plaque by percutaneous coronary intervention (PCI) distal embolisation (DE) is considered to be inevitable and it is associated with potential clinical and prognostic implications. This review aims to assess the main aspects of both spontaneous and procedural DE, analyze their different pathophysiology, provide specific insights on the main diagnostic tools for their identification, and finally focus on the main strategies for their treatment and prevention.

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The Impact of Circulating Cholesterol Crystals on Vasomotor Function

Abstract: Cholesterol crystals damaged the endothelium and reduced vasodilator response, potentially aggravating myocardial ischemia after interventions.

Cited by 35 publications

References 37 publications

Symptomatic and asymptomatic carotid artery plaque

Symptomatic and asymptomatic carotid artery plaque

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention

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