Kawakami Y, Hirose K, Watanabe Y, Tomioka N, Doyama K, Morikawa M, Kosuga K, Saiga T
Department of Cardiology, Otsu Red Cross Hospital, Shiga, Japan.
Angiology. 1990 Mar;41(3):248-52. doi: 10.1177/000331979004100311.
A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.
一名62岁男性接受了冠状动脉造影，并因急性心肌梗死接受了急性溶栓和抗凝治疗，随后出现了多系统损伤，包括肾功能不全和皮肤表现。眼底检查和皮肤活检标本确诊为多发性胆固醇栓塞综合征（MCES）。停用抗凝剂并给予止血药物（卡巴克络、氨甲环酸、立止血和维生素K）及抗高脂血症药物（消胆胺和普罗布考）后，皮肤和肾脏疾病暂时改善，生存期延长了约一年。除了严重的主动脉粥样硬化外，尸检发现多个器官有大量胆固醇栓子。MCES是左心导管插入术和抗凝治疗的一种罕见但严重的并发症，最佳治疗方案仍有待确定。作者在此建议上述治疗方法可能对MCES的治疗有效。
