LDL Apheresis in Cholesterol Crystal Embolization Patients: 6 Case Reports

Cholesterol crystal embolism （CCE） occurs when an atherosclerotic plaque is disrupted and cholesterol crystals within the plaque or portions of the plaque embolize distally. Although various therapies have been applied for its treatment, an effective method has yet to be developed. We herein presented six patients with CCE who underwent low-density lipoprotein apheresis （LDL-A）, with satisfactory outcomes being achieved in four. Our patients were diagnosed with CCE and underwent LDL-A between April 2008 to April 2014. A retrospective examination was performed on the presence or absence of improvements in cutaneous lesions and renal function; improvements were observed in four patients. Dialysis was initiated for the two patients who did not achieve improvements. Serum creatinine levels before the onset of CCE were significantly higher in the two patients receiving hemodialysis than in the four patients with improved cutaneous lesions and renal function. The results of this study suggest that LDL-A may be an effective treatment for CCE, and its effectiveness may be increased if patients have satisfactory renal function before the onset of CCE.