Cholesterol crystal embolism as complication of percutaneous coronary intervention

Author(s): Kotaro Takahashi, Ayumi Omuro, Masanobu Ohya, Shunsuke Kubo,Takeshi Tada, Hiroyuki Tanaka, Yasushi Fuku, Kazushige Kadota

Percutaneous Coronary Intervention (PCI) has become common treatment of coronary artery disease especially for acute coronary syndrome nowadays, while several complications cannot be completely prevented. Cholesterol Crystal Embolism (CCE) is one of the rare but serious complication of PCI, still occur even now that the PCI devices have been dramatically improved. CCE is a systemic disease caused by small atherosclerotic particles, often described as cholesterol crystals shower embolizing small vessels of each organs, leading to ischemic and inflammatory damage to single or multiple organs. This syndrome could occur spontaneously, while endovascular procedures, for example coronary angiography and PCI are the most affected iatrogenic causes. CCE as complication of PCI is recognized in cardiac interventionalists, while the data describing risk factors of CCE after PCI are scarce. This review will mainly discuss about the risk factors of CCE to consider how to reduce the risk of causing CCE, and whom to be aware of causing CCE in PCI performed patients.