Multisystemic Cholesterol Embolization after Carotid Stenting

Cholesterol embolization (CE) is well known as a multi-systemic disorder that frequently occurs after cardiac catheterization or cardiovascular surgery. CE after carotid stenting has been rarely reported. We describe a case in which carotid stenting triggered rapid progression to CE. Carotid stenting was performed in a 73-year-old man with severe stenosis of the left carotid artery. Peri-procedural magnetic resonance images revealed multi-focal acute brain infarctions. Ten days after the procedure, the patient developed hypertension, bilateral livedo reticularis of the toes, and renal dysfunction with eosinophilia. A skin biopsy showed evidence of cholesterol emboli in the arterioles. CE after carotid stenting was diagnosed. The patient received corticosteroid therapy including pulse therapy which was effective in diminishing further deterioration of renal function. CE should be suspected in patients who present with signs of ischemia following carotid stenting. Corticosteroids may prove beneficial in cases of CE-induced renal dysfunction.