Cholesterol Emboli

What are cholesterol emboli?

Cholesterol emboli are bits of plaque that break away from the wall of a large artery and travel through your blood. Plaque (atheroma) is a sticky substance that builds up in your arteries over time (atherosclerosis). The plaque may be stable for a long time, but sometimes, it can break apart (rupture). This may happen as a complication of certain medical procedures, such as a heart catheterization, or for other reasons.

When it ruptures, the plaque breaks into many small pieces. These bits of plaque material can travel through your blood in what healthcare providers call a “shower of microemboli.” Compared with blood clots that form on the surface of plaque, cholesterol emboli are smaller. And they’re made mostly of cholesterol crystals. So, they tend to get stuck in medium or small arteries, rather than large ones.

Once they’re lodged in smaller arteries, cholesterol emboli block blood flow to whatever parts of your body those arteries supply. Most often, cholesterol emboli affect blood flow to your kidneys and may lead to kidney failure. They may also travel to small arteries in your foot, particularly after a procedure such as a heart catheterization. But no matter where they’re lodged, cholesterol emboli may cause gradual damage to organs in your body and may also be fatal.

Healthcare providers use various terms to refer to cholesterol emboli and their effects on your body, including:

• Cholesterol embolization syndrome.
• Blue toe syndrome.
• Atheroembolism.
• Atheromatous embolization syndrome.
• Cholesterol-crystal embolization.
• Atheroembolic renal disease (when the cholesterol emboli affect your kidneys).

How common is this condition?

Researchers don’t know exactly how often cholesterol emboli occur. Cases that are severe enough to need treatment may affect up to 3% of adults. The condition mostly affects adults over age 60 with atherosclerosis and other forms of cardiovascular disease.

What are the signs and symptoms of cholesterol emboli?

Cholesterol emboli cause inflammation in your body that leads to these symptoms:

• Fatigue.
• Fever.
• Muscle pain (myalgia).
• Weight loss.

Other symptoms (things you notice) and signs (things your provider notices) can vary. It depends on which arteries are affected and what parts of your body those arteries supply with blood. The chart below lists some signs and symptoms based on where the cholesterol emboli become lodged.

Skin (usually on your feet or legs)

• Mottled skin (livedo reticularis).
• Purple or blue skin on your toe or other parts of your foot.
• Gangrene.
• Skin ulcers.
• Purpura.

Kidneys

• Signs and symptoms of kidney failure.

Digestive tract

• Pain in your abdomen (belly), back or flank.
• Bleeding.
• Diarrhea.

Brain

• Confusion.
• Memory loss.
• Dizziness.
• Headache.
• Transient ischemic attack (TIA).
• Stroke.

Eyes

• Eye pain.
• Blurred vision.
• Yellow crystals in your retinal arteries (Hollenhorst plaques).

What causes cholesterol emboli?

About 70% of the time, cholesterol emboli occur as complications of medical procedures involving your blood vessels, like a heart catheterization. Such procedures can disrupt plaque in your arteries, causing them to break apart.

When cholesterol emboli develop as a complication, it’s most often after an angiogram. It’s important to know that angiograms are typically safe and have a low risk of serious complications. But cholesterol emboli are one known, rare risk.

Rarely, cholesterol emboli can occur spontaneously, or without any clear cause.

What are the risk factors?

You face a higher risk for cholesterol emboli if you:

• Are over age 50.
• Are assigned male at birth (AMAB).
• Have extensive plaque buildup in your arteries (advanced atherosclerosis).
• Have risk factors for atherosclerosis, including high blood pressure, high cholesterol and diabetes.
• Smoke or use tobacco products.
• Have chronic kidney disease.

What are the complications of cholesterol emboli?

Cholesterol emboli can damage various organs in your body. These include your kidneys, skin, intestines and brain. Healthcare providers will do everything possible to treat any organ damage to give you the best chance of recovery.

How are cholesterol emboli diagnosed?

Cholesterol emboli can be challenging to diagnose. Many of the signs and symptoms are nonspecific, meaning they could point to many different problems. Your provider will give you a physical exam and talk with you about:

• Any symptoms you have.
• Your medical history.
• Any recent medical procedures you’ve had.

Your provider may order blood tests (complete blood count) to check for markers of inflammation or signs of kidney dysfunction. If your provider suspects cholesterol emboli, they may order a biopsy. This test checks tissue from some part of your body (usually your skin or kidney) for signs of cholesterol crystals.

How do you treat cholesterol emboli?

Healthcare providers tailor treatment to your needs and the severity of your condition. Treatment may include:

• Medications to manage cardiovascular disease risk factors. Your provider may prescribe blood pressure medications, statins and antiplatelet medications. These medications may help stabilize the plaque in your arteries. This can prevent future ruptures and cholesterol emboli.
• Lifestyle changes. Your provider may recommend lifestyle changes, like avoiding tobacco products. Such changes can support the health of your blood vessels and heart.
• Medications to reduce inflammation. Cholesterol emboli can cause inflammation throughout your body. Your provider may prescribe medications to lower inflammation, in turn, easing symptoms.
• Surgery. This is a last line of treatment in life-threatening cases. Your provider may recommend bypass surgery (to reroute your blood flow) or an endarterectomy if they know the exact location of the cholesterol emboli.

In addition, treatment may include supportive care in response to organ damage. For example, you may need:

• Dialysis to support your kidney function.
• Surgery to remove part or all of your colon.
• Amputation of a limb.

How can I lower my risk of cholesterol emboli?

Doing whatever you can to slow the progression of atherosclerosis can help lower your risk of cholesterol emboli. Steps you can take include:

• Avoid all tobacco products. If you currently smoke or use tobacco products, ask your provider for resources to help you quit.
• Eat a heart-healthy diet, like the Mediterranean diet.
• Exercise regularly, according to your provider’s guidance.
• Take your medications as your provider prescribes them.
• Visit your provider for a yearly check-up and keep all of your follow-up appointments.

What is the outlook?

Your outlook depends on many factors, including associated conditions and the extent of organ damage. Some research shows that kidney damage may lead to a poorer outcome.

Cholesterol emboli are sometimes fatal. Researchers estimate a 63% mortality rate. But that number can be higher or lower depending on the extent of organ damage and your overall condition.

Your healthcare provider is the best person to tell you about your outlook, or what you can expect going forward. They can evaluate your situation based on your medical history and current condition.

How do I take care of myself?

Your provider will tell you how to care for yourself at home. It’s important to follow their guidelines closely, including medication guidelines. Ask your provider if anything is unclear.

When should I see my healthcare provider?

Your provider will tell you how often you need to come in for appointments.

If your provider diagnoses you with cholesterol emboli, you’ll need long-term care to manage your condition and minimize damage to your organs. It’s vital to go to all of your appointments so you have the best possible chance of long-term survival.

When should I go to the ER?

Call 911 or your local emergency number if you have signs or symptoms of a TIA or stroke. These are medical emergencies that require immediate care.

What questions should I ask my provider?

Talk to your provider about your risk for cholesterol emboli and how to lower that risk. Specific questions you may want to ask include:

• What risk factors do I have for cholesterol emboli?
• What can we do to lower my risk if I need a cardiovascular surgery or procedure?
• What symptoms should I look out for?

If you’ve been diagnosed with cholesterol emboli, ask your provider:

• What treatment options can help me?
• What lifestyle changes should I make?
• What is my outlook?

A note from Cleveland Clinic

Cholesterol emboli are an unpredictable result of plaque buildup in your arteries. While certain factors can raise your risk of plaque rupture, it’s not always clear why emboli occur in some people but not in others. If your provider has diagnosed you with atherosclerosis, it’s important to do whatever you can to lower your risk of complications. This means working with your provider to take the best possible care of your blood vessels and heart.

Bring any questions or concerns you have to your provider. Talk about what you can do in your daily life to lower your risk of cholesterol emboli and other complications of cardiovascular disease.