Brief clinical observation

Vasculitis due to cholesterol embolism

Cholesterol microembolization may explain some treatment failures after renal artery stent placement. The identification of cholesterol crystals may provide significant help in diagnosing the real frequency and severity of this complication. The aim of the present study was to examine the efficacy of polarized light imaging in the detection of cholesterol emboli trapped in a protection device.

During a period of 18 months, 15 significant atherosclerotic stenoses of the ostium of the main renal artery were treated with primary stent placement with embolic protection. The filter device used was made of polyurethane, with a pore size of 115 μm. The device was mounted over a 0.014-inch guide wire. For pathologic analysis, the recaptured filter basket was compressed between two slides and examined in a microscope under polarized light.

All the stenoses were successfully treated without clinical complications. All the filters were deployed and recaptured without difficulty. Cholesterol crystals were detected in 12 filters and no cholesterol was found in three. In one case, trouble with filter manipulation precluded pathologic analysis. No worsening of renal function was detected in any patient during follow-up.

Microscopic analysis with polarized light easily detects the cholesterol crystals trapped in the filter device. This provides evidence that renal cholesterol microembolism is highly prevalent during renal artery stent placement.

Nous rapportons une observation de périartérite noueuse (PAN) révélée par des hémorragies cérébrales par rupture d'anévrismes. Une patiente de 40 ans a présenté à 12 jours d'intervalle deux hématomes intracérébraux, le second par rupture d'anévrismes. Le diagnostic de PAN a été porté sur l'histologie de l'anévrisme montrant des lésions de vascularite, sur l'artériographie évocatrice de PAN par ses localisations rénales et spléniques, sur l'altération de l'état général, et sur la présence depuis plusieurs années de nouures cutanées caractéristiques. L'évolution a été globalement favorable sous corticothérapie et cyclophosphamide. Les accidents vasculaires hémorragiques cérébraux sont rares dans la PAN et exceptionnellement révélateurs de la maladie.

We report a case of polyarteritis nodosa revealed by intracranial haemorrhage. A 40-year-old woman presented two episodes of cerebral haemorrhage twelve days apart, the second due to an aneurysm rupture. The diagnosis of polyarteritis nodosa (PAN) was based on the following criteria: histological aneurysm examination, angiography suggesting PAN with cerebral, renal and splenic localizations, loss of weight and cutaneous nodules. Cerebral haemorrhage in PAN is rare and exceptionally the presenting feature of the disease.