The recent article by Moolenaar and Lamers1 on cholesterol crystal embolization in the Netherlands, which was based on national pathologic data, is of interest, but the conclusions that were reached could impart a false impression of the frequency distribution of this phenomenon in the body. The authors assert that the primary site of what is usually referred to as atheroembolism is the kidney, followed by the skin and gastrointestinal tract. Atheroembolism in the kidney is more likely to result in clinical recognition because of the kidney's relatively high blood flow, functional importance, paucity of collateral flow, and the potential for secondary hypertension when the kidney is ischemic.
The study primarily concerns clinically manifest disease rather than the prevalence of atheroembolism per se, given that 67.2% of the pathology reports were based on antemortem reports of biopsies or resections and the remainder on autopsies with the potential for providing more
Stehbens WE. Atheroembolism or Cholesterol Crystal Embolization. Arch Intern Med. 1997;157(2):244-245. doi:10.1001/archinte.1997.00440230124021