Cholesterol embolisation after thrombolytic therapy

Cholesterol embolisation has been reported in 27 patients receiving thrombolytic therapy for acute myocardial infarction (MI). Since cholesterol embolisation is so difficult to diagnose ante mortem, it is possible that these cases represent the 'tip of the iceberg', and that cholesterol embolisation in this setting is far more common than usually suspected. However, the risks of cholesterol embolisation are far outweighed by the survival benefits of thrombolytic therapy in patients with MI. Nevertheless, clinicians should maintain a high level of suspicion when clinical manifestations suggestive of cholesterol embolisation appear after thrombolytic therapy, as the risk of morbidity and mortality can be high.