Mycinski C, Doll G, Lermusiaux P, Pacouret G, Lanotte R, Vaillant L, Desveaux B, Charbonnier B, Raynaud P, Brochier M L
Clinique cardiologique, CHU Trousseau, Tours.
Arch Mal Coeur Vaiss. 1990 Oct;83(11):1643-50.
Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.
胆固醇栓塞（CE）是由严重动脉粥样硬化病变中的胆固醇结晶迁移所致。直到最近，这仍被认为是动脉粥样硬化的一种典型但罕见的并发症。随着左心导管插入术技术的兴起，人们对该主题重新产生了兴趣。本文报告了9例左心导管插入术后发生的胆固醇栓塞病例，其中3例发生于冠状动脉血管成形术后，3例发生于相关溶栓治疗后。3例患者出现皮肤综合征（网状青斑、“紫趾综合征”），几周后预后良好。2例患者出现小肠节段性坏死，需要手术切除受累区域。最后，4例患者在导管插入术后12小时至3个月死亡：2例患者有多脏器受累；1例患者发生心源性休克；1例患者出现肠坏死，累及2/3的回肠和右结肠。这些病例说明了胆固醇栓塞表现的多样性及其潜在严重性。目前，唯一有效的措施是预防性的；治疗性治疗仍然特别令人失望。
