Coronary air embolism

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Coronary Angiography


General Principles

Historical Perspective
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Anatomy & Projection Angles

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Epicardial Flow & Myocardial Perfusion

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Lesion Complexity

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Preprocedural Lesion Morphology

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Coronary Artery Thrombus
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Lesion Morphology

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Left ventriculography

Quantification of LV Function
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]

Synonyms and keywords: Coronary artery air embolism; coronary air embolization


Coronary air embolism is a complication of coronary angiograpghy, in which there is an iatrogenic introduction of gas bubbles into the blood stream, that can be associated with high morbidity and even mortality. In this case, the signs and symptoms result from the cessation of the blood flow within the arterial segment, caused by even a small amount of bubbles, which lead to tissue ischemia from oxygen starvation and may cause cellular damage and irreversible injury. The most dangerous consequences occur in brain and heart due to their vulnerability to short periods of ischemia.[1]


The coronary air embolism is a result from the iatrogenic introduction of gas bubbles into the blood stream.[1]


The introduction of an air bubble in the coronary microcirculation can be explained by Laplace's law and may result in development of an air lock. Laplace’s law relates the pressure difference over a blood–air interface to the surface tension and the radius of the blood–air interface. The predominant mechanism is the air diffusion into the blood and surrounding tissues, leading to bubble shrinking, in wich, the severity of the cardiac impairment is related to the volume of air injected into the coronary arteries, the baseline cardiac function, and subsequent vascular responses such as vasospasm or distal air-lock. However, the size and volume of the bubbles have the most important roles in blood flow speed restoration. Furthermore, this diffusion is significantly enhanced by an increase in the mean arterial pressure and the partial pressure of oxygen in the arterial system.[2] Both conditions and also vasoconstriction may cause a division of bubbles more proximal in the vascular bed leading to more rapid dispersion of bubbles which develop a deleterious effect on the microvasculature decreasing the capillary bed space and so leading to a decrease in distal coronary blood flow.[1]


Iatrogenic Coronary Embolism
Mechanisms that may lead to air embolism during PTCA[3]
1 Incomplete aspiration of guiding catheter upon introduction into the vasculature
2 Balloon leakage or rupture
3 Prolonged negative suction of self-venting balloon catheters left outsidethe patient
4 Introduction of balloon catheters into the guiding catheter
5 Removal of balloon catheters from deeply seated guiding catheters
6 Structural failure of catheter

Epidemiology and Demographics

Risk Factors

Signs and Symptoms

Rare Signs and Symptoms


Clinical Significance


  • 100% oxygen
  • Analgesics
  • Monitorand treat arrhythmias
  • Circulatory support with pressors and intra-aortic balloon pump counter pulsation as necessary[4]
  • Intracoronary thrombus aspiration catheter systems which are the best options to resolve intracoronary air embolisms safely and harmlessly.[5]


Coronary Air Embolism
(Left Anterior Descending Artery; RAO Caudal)


  1. 1.0 1.1 1.2 Dib, J.; Boyle, AJ.; Chan, M.; Resar, JR. (2006). "Coronary air embolism: a case report and review of the literature". Catheter Cardiovasc Interv. 68 (6): 897–900. doi:10.1002/ccd.20880. PMID 17086533. Unknown parameter |month= ignored (help)
  2. Van Blankenstein, JH.; Slager, CJ.; Schuurbiers, JC.; Strikwerda, S.; Verdouw, PD. (1993). "Heart function after injection of small air bubbles in coronary artery of pigs". J Appl Physiol (1985). 75 (3): 1201–7. PMID 8226530. Unknown parameter |month= ignored (help)
  3. 3.0 3.1 3.2 Cheng, TO. (2009). "Coronary embolism". Int J Cardiol. 136 (1): 1–3. doi:10.1016/j.ijcard.2009.01.005. PMID 19181402. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Kahn, JK.; Hartzler, GO. (1990). "The spectrum of symptomatic coronary air embolism during balloon angioplasty: causes, consequences, and management". Am Heart J. 119 (6): 1374–7. PMID 2353622. Unknown parameter |month= ignored (help)
  5. Celik, A.; Ozeke, O. (2010). "Management of coronary air embolism during coronary stenting". Kardiol Pol. 68 (6): 716–8, discussion 719. PMID 20806212. Unknown parameter |month= ignored (help)

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