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Aspiring Use of a Thrombectomy Catheter for Coronary Air Embolism Aspiration
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A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI following an anterior ST-elevation myocardial infarction treated with thrombolysis at a nearby clinic.
During the procedure, an inadvertent air entry into the left coronary arterial system occurred (Figure A; Video 1), and the patient promptly experienced chest pain and electrocardiographic changes.
Recognizing the critical nature of the situation, a 6-French thrombectomy catheter (Export Advance; Medtronic), typically used for thrombus aspiration, was employed proximal to the air bubble (Figure B). Using a controlled suction technique, the catheter successfully drew the air embolus into its lumen (Video 2), immediately restoring Thrombolysis in Myocardial Infarction (TIMI) 3 blood flow (Figure C; Video 3).
Coronary air embolism (CAE) is a known but rare complication of cardiac catheterization procedures, and it can occur due to suboptimal manifold preparation, poor connections, pressure dampening, the use of large devices, trapping techniques, or balloon rupture.
Although there is no optimal technique to restore blood flow after CAE, treatment options include auxiliary supportive measures like intracoronary epinephrine or 100% oxygen to accelerate air embolus reabsorption and mechanical methods like air aspiration with balloon-assisted deep intubation, disruption, or dislodgement by guidewire manipulation or forcefully injecting saline to fragment the air embolus and allow dispersal or force it distally.
The use of non-dedicated devices for aspiration, like over-the-wire balloons or angiography catheters, may be limited in their effectiveness and carry risks of damage or perforation. In contrast, the Export aspiration catheter offers advantages like flexibility, slenderness, and a relatively large lumen that allows for efficient removal of intracoronary debris.
This case underscores the successful use of a thrombectomy catheter for managing CAE and highlights the importance of prompt recognition, appropriate equipment selection, and swift intervention to prevent potentially catastrophic events during cardiac procedures.
Affiliations and Disclosures
From the Cardiology Department, Trikala Hospital, Trikala, Thessaly, Greece.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Dimitrios Karelas MD, MSc, R. Feraiou 13, 43100, Karditsa, Greece. Email: dim.f.karelas@gmail.com
