A 73-year-old ex-smoker with a history of hyperlipidaemia and triple aorto-coronary by-pass surgery eleven years earlier, who was admitted for clinical symptoms of one month's evolution with dyspnoea and angina on slight exertion. For this reason, a coronary angiography by cardiac catheterisation was performed, which showed a three-vessel coronary artery disease with non-revascularisable obstruction of the saphenous bridge to obtuse marginal. Prior to the procedure, the patient was being treated with an antiplatelet agent and had moderate renal insufficiency (creatinine 3.7 mg/dl), which did not contraindicate the study.
Since the catheterisation, the patient presented a general syndrome with asthenia and anorexia, and a blood test two weeks later showed a worsening of his renal function, with creatinine of 7.5 mg/dl and eosinophilia of 13%, for which he was admitted on suspicion of acute renal failure due to CES after cardiac catheterisation. Due to the progressive increase in creatinine, he required haemodialysis, and new signs included purple spots on the lateral area of the foot (livid reticularis), a biopsy of which did not reveal cholesterol emboli.
Referred to ophthalmology 40 days later for fundus examination, he presented the following ophthalmological examination: visual acuity (VA) was 0.8 in both eyes, intraocular pressure (IOP) was 13 mm Hg and in the right eye fundus (OD) a microhaemorrhage was observed above the papilla and four cholesterol emboli and in the left eye fundus (OI) another two emboli located in the temporal and nasal branch.
Subsequently, the patient went into heart failure, accompanied by signs and symptoms of acute peripheral ischaemia, with worsening general condition and progressive obnubilation until his death 73 days after coronary angiography. Necropsy revealed numerous cholesterol emboli in the vascular structures of the thyroid, pancreas, heart, spleen, liver and kidneys.