Cholesterol crystal embolization after staged angioplasty for severe carotid artery stenosis
Objective: Staged angioplasty is an effective and safe carotid revascularization technique that avoids complications associated with postoperative cerebral hyperperfusion syndrome. Cholesterol crystal embolization (CCE) is a rare but severe complication of interventional and surgical procedures. Here in, we report on a patient with cholesterol crystal embolization who underwent staged angioplasty for severe carotid artery stenosis. Case Report: A 72-year-old man with chronic kidney disease and dyslipidemia presented with left-sided homonymous hemianopsia. MRI showed an acute cerebral infarction in the right occipital lobe, and cerebral angiography confirmed severe right internal carotid artery stenosis. We planned a staged angioplasty for carotid artery stenosis owing to concerns about postoperative cerebral hyperperfusion syndrome because preoperative single-photon emission CT showed decreasing cerebral blood flow on the affected side. Staged angioplasty was performed smoothly; however, after treatment, the patient developed worsening chronic renal failure, immense pain in the right fifth toe, and livedo extending from the toes to the plantar surface on both feet. Skin biopsy confirmed the presence of cholesterol crystal embolization, owing to which he was required to receive dialysis and undergo toe amputation. Conclusion: Because staged angioplasty requires multiple catheter operations, careful attention must be paid to the occurrence of cholesterol crystal embolization. To our knowledge, this is the first report of a rare complication associated with staged angioplasty.
