CEREBRAL AIR EMBOLI FROM ANGIOGRAPHY IN A PATIENT WITH STROKE. A case report

Söderman, Michael; Bystam, J.

doi:10.1034/j.1600-0455.2001.042002140.x

Cited by 10 publications

(4 citation statements)

References 9 publications

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“…Animal studies (Annane et al ., 1994, 1995) and several clinical case reports have used computed tomography (CT) to demonstrate the presence of CAE (Hwang et al ., 1983; Hirabuki et al ., 1988; Hashimoto et al ., 2000; Takizawa et al ., 2000; Inamasu et al ., 2001; Sakai & Nishizawa, 2001; Söderman, 2001). On the other hand, Hodgson and colleagues studied 47 divers with neurologic/pulmonary symptoms by CT scanning and were unable to show any evidence of CAE in any of the divers (Hodgson et al ., 1988).…”

Section: Radiographic Techniquesmentioning

confidence: 99%

Gas embolism: pathophysiology and treatment

Hulst

Klein

Lachmann

2003

Clin Physio Funct Imaging

193

194

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Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and then addresses venous air embolism by discussing pulmonary vascular filtration, entrapment, and the clinical occurrence of venous air emboli. The section on arterial gas embolism deals with the main mechanisms involved, coronary and cerebral air embolism (CAE), and the effects of bubbles on the blood-brain barrier. The diagnosis of CAE uses various techniques including ultrasound, perioperative monitoring, computed tomography, brain magnetic resonance imaging and other modalities. The section on therapy starts by addressing the primary treatment goals and the roles of adequate oxygenation and ventilation. Then the rationale for hyperbaric oxygen as a therapy for CAE based on its physiological mode of action is discussed, as well as some aspects of adjuvant drug therapy. A few animal studies are presented, which emphasize the importance of the timing of therapy, and the outcome of patients with air embolism (including clinical patients, divers and submariners) is described.

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Section: Radiographic Techniquesmentioning

confidence: 99%

Gas embolism: pathophysiology and treatment

Hulst

Klein

Lachmann

2003

Clin Physio Funct Imaging

193

194

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“…In the literature, most case reports on symptomatic air embolism are described during cerebral 20,21 and coronary angiography. 15,22 Numerous small air emboli have been demonstrated during catheter flushing 23 and contrast medium injections.…”

Section: Bendszus Et Al Heparin and Air Filters Reduce Embolic Eventsmentioning

confidence: 99%

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

et al. 2004

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Background-Intra-arterial cerebral angiography is associated with a low risk for neurological complications, but clinically silent ischemic events after angiography have been seen in a substantial number of patients. Methods and Results-In a prospective study, diffusion-weighted magnetic resonance imaging (DW-MRI) before and after intra-arterial cerebral angiography and transcranial Doppler sonography during angiography were used to evaluate the frequency of cerebral embolism. One hundred fifty diagnostic cerebral angiographies were randomized into 50 procedures, each using conventional angiographic technique, or systemic heparin treatment throughout the procedure, or air filters between the catheter and both the contrast medium syringe and the catheter flushing. There was no neurological complication during or after angiography. Overall, DW-MRI revealed 26 new ischemic lesions in 17 patients (11%). In the control group, 11 patients showed a total of 18 lesions. In the heparin group, 3 patients showed a total of 4 lesions. In the air filter group, 3 patients exhibited a total of 4 lesions. The reduced incidence of ischemic events in the heparin and air filter groups compared with the control group was significantly different (Pϭ0.002).Transcranial Doppler sonography demonstrated a large number of microembolic signals that was significantly lower in the air filter group compared with the heparin and control groups (PϽ0.01), which did not differ from each other. Conclusions-Air filters and heparin both reduce the incidence of silent ischemic events detected by DW-MRI after intra-arterial cerebral angiography and can potentially lower clinically overt ischemic complications. This may apply to any intra-arterial angiographic procedure.

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“…There have been cases described following pulmonary biopsy,3 4 use of venous catheters,5 angiography6 and even related to contrast injection 7. It may also happen secondary to traumatic events and in scuba-diving incidents 8…”

Section: Discussionmentioning

confidence: 99%