Republished: Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration

Abstract

Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.

Cerebral air embolism after computed tomography-guided percutaneous transthoracic lung biopsy: a case description

“…Interestingly, we found a case report of successful treatment of middle cerebral artery air embolism with intravascular aspiration ( 16 ). Acute reperfusion therapy with thrombolytic agents or mechanical thrombectomy has not been validated for the treatment of air embolism.…”

Iatrogenic stroke caused by cerebral air embolism and acute reperfusion therapy using hyperbaric oxygen

“…However, we identified one case report successfully treating air embolus occlusion of the middle cerebral artery using endovascular aspiration. 8 There are no data to our knowledge comparing endovascular versus hyperbaric treatment. In the present case, the emboli were multifocal and peripheral and thus deemed not suitable for an endovascular approach.…”

Ischemic Stroke Following Sclerotherapy of Varicose Veins

“…Among the strokes reported after sclerotherapy, two entities have been described; early-onset stroke, linked to paradoxical air embolism, which is a specific complication of foam sclerotherapy (12,16), and stroke secondary to paradoxical thrombotic embolism, with late-onset symptoms , which appeared as a result of various methods of treating varicose veins (17,18).It was specified by the experts thatpatients who experienced istroke did not have an intracerebral clot but air bubbles were reported in the cerebral arteries (19)(20)(21)(22).Therapeutically, in the event of gas embolism several articles report the effectiveness of hyperbaric oxygen therapy. In the event of persistent deficiency, classic revascularization procedures such as thrombolysis and/or thrombectomy are used (23).…”