Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Masuda, Jun; Tsuruo, Takashi; Nakamori, Shiro; Sawai, Terumitsu; Murata, Tetsuya; Ishikawa, Eiji; Yamada, Norikazu; Nakamura, Mashio; M, Ito

doi:10.2169/internalmedicine.52.9255

Cited by 13 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have suggested efficacy of corticosteroids; however, no ideal dosage or durations of administering corticosteroids have been established . Although five patients were treated with pulse therapy, an average of initial dose of oral prednisolone was 23 mg/day, which was similar to past studies .…”

Section: Discussionsupporting

confidence: 75%

“…Although various treatments including corticosteroids and statin therapy have been attempted based on pathophysiology and comorbidity, there is currently no established treatment other than supportive therapy. Low‐density lipoprotein apheresis (LDL‐A) has been approved for arteriosclerosis obliterans in Japan, and has also been attempted in patients with CCE; however, the efficacy of LDL‐A for CCE has only been evaluated in a few case reports, and no clinical studies have been performed.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Low‐Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism

2015

View full text Add to dashboard Cite

Drugs such as corticosteroids and statins have been used to treat cholesterol crystal embolism (CCE), but the prognosis remains poor. This study evaluated the efficacy of low-density lipoprotein apheresis (LDL-A) in patients with CCE. Patients with CCE who showed renal deterioration after vascular interventions were studied retrospectively. Information on demographic variables, clinical measurements, and medication use was collected. The outcomes were incidence of maintenance dialysis and mortality at 24 weeks. A total of 49 patients with CCE were included, among whom 37 (76%) were diagnosed pathologically and the remainder were diagnosed clinically. The median estimated GFR at baseline and at diagnosis were 40.5 and 13.4 mL/min per 1.73 m(2) , respectively. Corticosteroids were used in 42 patients (86%), statins in 30 patients (61%), and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in 29 patients (59%). LDL-A was performed in 25 patients (LDL-A group), and not in 24 patients (control group). Smoking (100% vs. 72%, P = 0.02), white blood cell count (8900/mm(3) vs. 7000/mm(3) ) and corticosteroid use (96% vs. 75%) were higher in the LDL-A group compared with the control group, but there were no differences in other demographic and clinical parameters between the groups. Patients in the LDL-A group had a lower incidence of maintenance dialysis (2/25 (8%) vs. 8/24 (33%), P < 0.05), and a trend towards lower mortality (2/25 (8%) vs. 7/24 (29%), P = 0.074). These results suggest that LDL-A decreases the risk of maintenance dialysis in severe renal CCE patients after vascular interventions.

show abstract

Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

Low‐Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism

2015

View full text Add to dashboard Cite

show abstract

“…Treatment of CCE mainly comprises of supportive care, including pain control, blood pressure management, and dialysis [ 7 ]. Although corticosteroids and low-density lipoprotein apheresis may reduce the recurrence of CCE [ 13 , 14 ], the benefit of this therapy has not been totally established [ 7 ]. Antiplatelet therapy or anticoagulation therapy does not prevent CCE; these therapies rather increase the risk [ 7 ].…”

Section: Case Presentationmentioning

confidence: 99%

A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism

et al. 2018

View full text Add to dashboard Cite

BackgroundCholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by CCE after functional end-to-end anastomosis (FEEA). To our knowledge, this is the first report of CCE causing such an anastomotic stenosis.Case presentationA 77-year-old male patient underwent laparoscopy-assisted low anterior resection and protective ileostomy for rectal carcinoid tumor. He was admitted to our hospital with ileus 1 year after stoma closure. Eosinophils and creatine kinase level were slightly elevated. Computed tomography revealed a stricture with thickened intestinal wall just distal to the anastomosis site of the ileostomy. The wall of the descending aorta appeared shaggy due to thrombosis. The patient underwent laparoscopic small-bowel resection because ileus reoccurred after any oral intake.Histopathological findings of the resected specimen showed fibrotic changes distal to the anastomosis site, and needle-shaped cholesterol embolus was observed in the submucosal layer. Thus, the stenosis was considered to be caused by CCE.ConclusionThis appears to be the first published report of stenosis due to CCE at such an anastomotic site. Intestinal CCE is difficult to diagnose preoperatively and is associated with poor prognosis. If eosinophilia is present or shaggy aorta is observed, CCE should be suspected to make correct diagnosis and prevent recurrence of CCE.

show abstract

“…Although it was first reported by Fenger et al 1) in 1844, there is still no consensus on its definitive treatment. Treatment of cholesterol embolism with anti-inflammatory agents, including corticosteroids, has been reported, 2 – 4) but the treatment results have been varied and often disappointing. Therefore, the main treatment modality continues to be supportive treatment, which generally comprises fluid supplementation, blood pressure control, and nutritional and metabolic support.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Cholesterol Embolism With Corticosteroids and Alprostadil

Jung

2019

Ann Geriatr Med Res

View full text Add to dashboard Cite

Cholesterol embolism is a rare but serious disease that can lead to chronic renal failure or death. Despite the recent increase in the incidence of this disease, there is no consensus on the optimal treatment modality. Supportive care is usually the mainstay of treatment. We report a case of cholesterol embolism after renal artery stenting that was successfully treated with corticosteroids and alprostadil.

show abstract

Use of Corticosteroids in the Treatment of Cholesterol Crystal Embolism after Cardiac Catheterization: A Report of Four Japanese Cases

Cited by 13 publications

References 21 publications

Low‐Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism

Low‐Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism

A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism

Treatment of Cholesterol Embolism With Corticosteroids and Alprostadil

Contact Info

Product

Resources

About