Coronary Artery Air Embolism

J INVASIVE CARDIOL 2019;31(8):E264.

Key words: angiography, complications, coronary intervention

A 55-year-old male was admitted to the cardiology unit with anterior-wall myocardial infarction and post-infarct angina. He was a known smoker and hypertensive. A coronary angiography was planned; during angiography, the left coronary artery was selectively engaged with a 6 Fr Judkins left 3.5 diagnostic catheter and a cineangiography shot was taken. However, accidental injection of air bubbles into the left system led to total abrupt occlusion of the left anterior descending coronary artery (Figures 1A and 1B; Videos 1 and 2). The electrocardiography tracing revealed new ST-segment elevation in the anterior leads and the patient complained of chest pain. Immediate intracoronary nicorandil was administered and the guidewire passed, with 100% oxygen started via nasal cannula. The coronary spasm resolved with these interventions (Figure 1C). Angioplasty of the proximal diseased segment was performed with drug-eluting stent implantation and the patient was discharged later in stable condition (Figure 1D).

Coronary artery air embolism is a preventable complication of coronary interventions; it can be fatal if not proficiently managed. Vasospasm is said to be protective in that it breaks the larger air bubbles, as occurred in the present case.

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From the Institute of Post Graduate Medical Education & Research, Kolkata, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 10, 2019.

Address for correspondence: Rakesh Agarwal, MBBS, MD (Internal Medicine), CCEBDM, Post Doctoral Trainee and Senior Resident, Department of Cardiology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata-20, India. Email: dr.agarwal.rakesh@hotmail.com