Air embolism in the right coronary artery occurring during the left coronary angioplasty using the guiding catheter with a side hole

Abstract

Coronary air embolism is one of the inadvertent complications of coronary angioplasty. We report two rare cases of complicating air embolism in the right coronary artery occurring during control left coronary angiography using a guiding catheter with a side hole, just prior to a coronary intervention procedure for a left coronary artery lesion. The air seemed to be injected into the right coronary artery through the side hole. When we use an angiographic or guiding catheter with a side hole, we should be aware that an air embolism can occur in the contralateral coronary artery and should carefully and repeatedly perform aspiration of the catheter. Cathet. Cardiovasc. Intervent. 49:331–334, 2000. © 2000 Wiley‐Liss, Inc.

Massive right coronary air embolism in the right coronary artery during left coronary angiography: A case report

“…However, the mechanism of contralateral air embolism is unclear. Inoue et al (4) reported similar cases and insisted that the air was injected through the sidehole. However, we used a diagnostic catheter without a sidehole so this does not explain the mechanism of contralateral air embolism.…”

“…When large amounts of air are involved, more aggressive modalities, including air aspiration and forceful injection of saline or contrast medium are suggested (2,3,6,7). Previously, stirring the mass of air using a 0.014-inch guidewire and balloon catheter for coronary angioplasty has also been suggested, which worked by breaking up the larger air mass into a number of smaller bubbles to increase the surface area (4). …”

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

“…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. 13 , 14 Aspiration has been attempted with diagnostic or guide catheters and export aspiration catheters. 15 Another case showed that intracoronary thrombus aspiration catheter systems can be used safely and harmlessly to resolve air embolism.…”

Massive coronary air embolism successfully treated with intracoronary catheter aspiration and intracoronary adenosine

“…The first steps in the management of CAE are the administration of intravenous saline and high flow oxygen to aid the resorption of the air bubbles. When there are significant amount of CAE, the usage of coronary wire, coronary balloon, aspiration catheter and forceful injection of saline or contrast has been advocated [1][2][3][4]. …”

“…There are only 2 reported cases of contralateral CAE in the literature [1,2] with one postulation mentioned being about the possible mixture of the culprit blood-air-contrast bouncing off from the left cusp towards the right cusp and into the RCA [3]. The first steps in the management of CAE are the administration of intravenous saline and high flow oxygen to aid the resorption of the air bubbles.…”