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Cholesterol crystal embolization following plaque rupture： a systemic disease with unusual features

The Journal of Biomedical Research 2017年第2期31卷 82-94页

作者： Firas Ghanem Deepthi Vodnala Jagadeesh K. Kalavakunta Sridevi Durga Noah Thormeier prem subramaniyam Scott Abela George S. Abela Department of Medicine Division of Cardiology College of Human Medicine Michigan State University East Lansing MI 48824 USA Wheaton Franciscan Health Brookfield WI 53005 USA University of Missouri St. Luke's Health System Kansas City MO 64111 USA Borgess Hospital Kalamazoo MI 49048 USA College of Osteopathic Medicine Michigan State University East Lansing MI 48824 USA Department of Physiology Division of Pathology College of Human Medicine Michigan State University East Lansing MI 48824 USA.

Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.

关键词： cholesterol crystal embolic syndrome plaque rupture cholesterol crystal pathogenesis clinicalpresentation diagnosis

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