Renal cholesterol embolism in patients with carotid stenosis: a severe and underdiagnosed complication following cerebrovascular procedures

Hagiwara, Noriko; Toyoda, Kazunori; Nakayama, Masaru; Inoue, Tooru; Yasumori, Kotaro; Ibayashi, Setsuro; Okada, Yasushi

doi:10.1016/j.jns.2004.04.003

« Previous Next »Journal of the Neurological Sciences
Volume 222, Issue 1 , Pages 109-112, 15 July 2004

Renal cholesterol embolism in patients with carotid stenosis: a severe and underdiagnosed complication following cerebrovascular procedures

Noriko Hagiwara
- Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuou, Fukuoka 810-8563, Japan
Kazunori Toyoda
- Corresponding author. Tel.: +81-92-852-0700; fax: +81-92-847-8802.
- Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuou, Fukuoka 810-8563, Japan
Masaru Nakayama
- Department of Nephrology, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka 810-8563, Japan
Tooru Inoue
- Department of Neurosurgery, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka 810-8563, Japan
Kotaro Yasumori
- Department of Neuroradiology, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka 810-8563, Japan
Setsuro Ibayashi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Yasushi Okada
- Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuou, Fukuoka 810-8563, Japan

Received 4 November 2003; received in revised form 4 March 2004; accepted 6 April 2004.

Abstract

Here, we report two cases with rapidly progressive renal failure, caused by cholesterol crystal embolism (CCE), after an angiography for carotid artery stenosis. The diagnosis was determined by histological examination and from clinical symptoms, including livedo reticularis and eosinophilia. Neurologists and neuroradiologists tend to underdiagnose CCE, which results from the same atherosclerotic risk factors as cerebrovascular disease. We need to understand more about CCE and identify its unique clinical symptoms to enable an early diagnosis and treatment.

Keywords: Cholesterol crystal embolism, Carotid artery stenosis, Angiography, Carotid endarterectomy, Antithrombotic therapy, Renal infarction