Use of corticosteroids in the treatment of cholesterol crystal embolism after cardiac catheterization: a report of four Japanese cases

Intern Med. 2013;52(9):993-8. doi: 10.2169/internalmedicine.52.9255. Epub 2012 Mar 1.

Abstract

Cholesterol crystal embolism (CCE) is a serious complication associated with invasive vascular procedures. The prognosis of the renal involvement type of CCE is very poor, and there is currently no established treatment, other than supportive therapy. We herein report four cases of CCE with severe atherosclerosis wherein the renal function progressively deteriorated after cardiac catheterization. In three of the four patients, low-dose corticosteroids (0.3 mg/kg/day) improved the renal function, whereas the fourth patient died from CCE of the digestive system. This report reviews the literature on CCE and discusses possible therapeutic options.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Aortography / adverse effects
  • Cardiac Catheterization / adverse effects*
  • Comorbidity
  • Coronary Angiography / adverse effects
  • Coronary Disease / complications
  • Coronary Disease / diagnosis
  • Crystallization
  • Embolism, Cholesterol / drug therapy
  • Embolism, Cholesterol / etiology*
  • Fatal Outcome
  • Humans
  • Intestinal Perforation / etiology*
  • Intestines / blood supply
  • Ischemia / etiology
  • Leg / blood supply
  • Livedo Reticularis / etiology
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / complications
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use*
  • Recurrence
  • Toes / blood supply
  • Warfarin / adverse effects

Substances

  • Warfarin
  • Prednisolone