The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: Results after a mean of 15 months follow-up

Carroccio, Antonio; Olin, Jeffrey W.; Ellozy, Sharif H.; Lookstein, R.; Valenzuela, Rolando; Minor, Michael; Sheahan, Claudie; Teodorescu, Victoria; Marin, Michael L.

doi:10.1016/j.jvs.2004.06.036

Cited by 33 publications

(21 citation statements)

References 20 publications

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“…To eliminate the embolic source, percutaneous transluminal angioplasty and stent placement have been undertaken in a few patients with aortoiliac and femoral artery sources of embolisation. 93,94 These endovascular procedures could also be associated with a high risk of further embolisation, …”

Section: Treatmentmentioning

confidence: 99%

Atheroembolic renal disease

2010

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Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often aff ects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis diffi cult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confi rmed by biopsy of an aff ected organ or by the fundoscopic fi nding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be off ered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic infl ammation.

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Section: Treatmentmentioning

confidence: 99%

Atheroembolic renal disease

2010

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“…In a prospective study of 660 patients with a mean follow-up of 15.3Ϯ15 months (range, 1 to 60 months), signs and symptoms of cholesterol embolization syndrome developed in 19 patients (2.9% of patients with abdominal aortic aneurysm). 23 …”

Section: Atheromatous Plaque In a Proximal Arterymentioning

confidence: 99%

“…Stenting, in addition to protecting the patient from aortic rupture, may also be an effective strategy to prevent future cholesterol embolization from abdominal aortic aneurysm. 23 Other embolizing arterial lesions (such as those in the iliac or subclavian arteries) may also be treated with endoluminally placed stent grafts to prevent future cholesterol embolism. 90 …”

Section: Treatmentmentioning

confidence: 99%

Cholesterol Embolization Syndrome

2010

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“…Limited experience in patients with abdominal aortic aneurysm or those with mostly an aortoiliac embolic source showed significant healing of ischemic ulcerations and decrease of further embolization [ 58- 59 ] . Finally, modifications in endovascular and surgical approaches can have additional benefits to the use of protection devices.…”

Section: Managementmentioning

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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The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: Results after a mean of 15 months follow-up

Cited by 33 publications

References 20 publications

Atheroembolic renal disease

Atheroembolic renal disease

Cholesterol Embolization Syndrome

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

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