BMJ Case Reports 2018; doi:10.1136/bcr-2018-225558
  • Novel diagnostic procedure

Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

  1. Kazuhisa Kodama3
  1. 1Department of Pathology, Amagasaki Central Hospital, Amagasaki, Japan
  2. 2Department of Pathology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
  3. 3Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
  1. Correspondence to Dr Chikao Yutani, cyutani{at}
  • Accepted 17 June 2018
  • Published 11 July 2018


The number of released free cholesterol crystal emboli (fCCE) and their role during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have not been documented yet. Furthermore, fCCE manifesting in the coronary lumen following plaque rupture has been historically overlooked owing to the standard tissue preparation for light microscopy which uses ethanol as a dehydrating agent that can dissolve fCCE, leaving behind empty tissue. In this case report, we evaluated fCCE released during PCI for ACS and their relationship with myocardial injury and coronary artery obstruction on the H&E-stained sections by using polarised light microscopy. To our knowledge, there has been no mention of the visibility of fCCE on H&E-stained frozen polarised sections before.


  • Contributors CY wrote the first version of the manuscript. TN and SK performed the supervision of the manuscript and gave expert opinion. KK supervised all the processes and gave final approval for the version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KK, who is the president of Inter-tec Medicals, Co., developed non-obstructive angioscopy. SK is a technical consultant for Nemoto Kyorin-do Co.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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