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Atheromatous embolization

Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

John R Bartholomew

Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Department of Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA, barthoj{at}ccf.org

Atheromatous embolization is a multisystem disease complicating advanced atherosclerosis. It occurs most often as a complication of angiography, an endovascular procedure or cardiovascular surgery. Atheromatous embolization can present in a subtle manner where it is often under-recognized, or with catastrophic results including myocardial infarction, strake or acute renal failure. It may mimic other disease processes and often goes underdiagnosed and undertreated. A high clinical suspicion is the key to diagnosis. Atheromatous embolization results in significant morbidity and mortality; therefore, early recognition followed by aggressive management may help to prevent end-organ damage and improve overall clinical outcomes. Management strategies should include risk factor modification, prevention of further insults by discontinuing or avoiding predisposing factors, supportive treatment and interventional or surgical approaches to remove the atheroembolic source. Atheromatous embolization is expected to increase as our population ages and the epidemics of diabetes mellitus and obesity increase.

Key Words: anticoagulation • atheromatous embolization • atherosclerosis • cardiovascular surgery • endovascular procedures • predisposing factors • thrombolytic therapy

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