Thread by @MoreXGrok

A 63-year-old man

👉developed purplish discoloration of his face after he underwent stenting and balloon dilation of the left CCA

What is the name of this finding?

Cutis marmorata

Harlequin syndrome

Livedo racemosa

Livedo reticularis

Telangiectasia

Shivering, sweating, and confusion developed immediately after artery dilation,

👉along with a left gaze preference, dysarthria, and hemiparesis on the right side of his body
*
Over the next 20 minutes, livedo reticularis developed on the left side of his face

An embolic protection device had been used during the procedure
*
Digital subtraction angiography

👉 patent left internal carotid artery

👉 an occluded distal left facial artery
*
No intracranial hemorrhage was seen on CT of the head

👉 transferred to the (ICU),

👉 MRI and angiography of the brain revealed

👉 infarctions in the territory of the lt middle cerebral artery with patent vasculature
*
An acute embolic stroke and cholesterol embolization syndrome of the face were diagnosed

An embolic protection device had been used during the procedure
*
Digital subtraction angiography

👉 patent left internal carotid artery

👉 an occluded distal left facial artery
*
No intracranial hemorrhage was seen on CT of the head

👉cholesterol embolization syndrome, atherosclerotic plaque contents from large-caliber arteries embolize to smaller arteries

👉 lead to vascular occlusion, inflammation, and end-organ damage

Livedo reticularis is one of the most common skin manifestations of the syndrome
♦️
👉 received supportive care in the IC

👉 livedo reticularis resolved 1 week after the event

👉 neurologic deficits persisted at the time of his discharge from the hospital 2 months later.

Livedo reticularis

Cholesterol Embolization Syndrome after Carotid-Artery Stenting
nejm.org/doi/full/10.10…