A Case of Coronary Air Embolism of the Left Coronary Arteries that Manifested as Cardiogenic Shock

Abstract

Coronary air embolism remains a serious complication of coronary catheterization despite performing careful procedure to prevent this. We report here on a case of massive coronary air embolism that was complicated by cardiogenic shock in a 52-year-old male patient with angina pectoris. The patient had a stenosis in the middle left anterior descending artery (LAD) and percutaneous coronary intervention (PCI) was planned for the LAD lesion. During PCI, inadvertent manipulation of a pressure line induced massive air embolism in both proximal left coronary arteries, and this manifested as cardiogenic shock. The patient recovered after supportive measures and successive intracoronary injections of nitroglycerin and then he eventually underwent successful PCI.

Massive coronary artery air embolism due to an unusual cause

“…The signs and symptoms associated with air embolism result from the interruption of blood flow within the artery [ 3 ]. The clinical presentation of coronary air embolism includes chest pain, hypotension, life-threatening arrhythmias, ECG changes of myocardial ischemia, and even cardiac arrest [ 2 – 5 ]. The severity of symptoms is proportional to the introduced air’s volume, the number of affected vessels, and the extent of the baseline myocardial dysfunction [ 3 ].…”

“…Coronary air embolism is an uncommon but well-recognized complication of coronary catheterization that occurs in 0.1%–0.3% of cases, most frequently in angioplasty cases [ 1 – 4 ]. Most often, air embolism occurs due to inadequate aspiration and flushing of catheters [ 5 ].…”

Multiple Air Embolism during Coronary Angiography: How do We Deal with it?

“… 9 In addition, inotropes, intracoronary vasodilators, and intra-aortic balloon pump may be used to maintain the coronary blood flow. 10 , 11 If massive air embolism occurs, we need to restore the coronary blood flow as quick and safe as possible in order to reduce injury to myocardium and recover from the hemodynamic crisis. Case reports have described mechanical methods including aspiration of the bubbles ( sucking method ), 12 disruption or dislodgement by the guidewire, and forceful injection of saline ( pushing method ) to fragment the air embolus and allow dispersal distally.…”