What is cholesterol embolism syndrome?

Updated: Oct 25, 2019
  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Cholesterol embolism syndrome (CES) should be suspected in a patient who develops worsening renal function, [1]  hypertension, distal ischemia, or acute multisystem dysfunction after an invasive arterial procedure. Atheroemboli may also occur spontaneously.

Key components of CES include proximal large-caliber arterial plaque, plaque rupture with embolization of debris, mechanical occlusion of small arteries, intense foreign-body inflammation, end-organ damage from mechanical obstruction, and inflammatory vascular changes. The protean manifestations of this syndrome make the diagnosis challenging. 

Any risk factor for atherosclerotic disease is a risk factor for cholesterol embolism.

Cholesterol embolism is a disease of persons ranging from middle-aged to elderly, with a minimum age of 50 years. Men are at higher risk than women are. As the population ages, the incidence of this syndrome will increase.

Medical management of CES is supportive. Pharmacologic therapy has not been particularly successful. Surgical therapy (eg, aortic aneurysm resection) may be necessary to remove the source of atheroembolic material. Stent-grafting may be a less invasive method to reduce embolization risk.


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