A rare entity of intra–arterial embolism in neurointerventional suite

Introduction: Symptomatic arterial embolism during neurointerventional procedures is a rare complication which can result in catastrophic consequences. We report a rare case of arterial embolism during endovascular coiling of basilar top aneurysm in a patient, who developed cardiac arrest intraoperatively and developed complication after cardiopulmonary resuscitation and was managed successfully. Case Summary: A 79 years old woman who was undergoing elective endovascular balloon assisted coiling of an unruptured large basilar top aneurysm suddenly had a fall in end-tidal CO2 followed by cardiac arrest. The occurrence of arterial air embolism was simultaneously alerted by the neurointerventionist. Cardiopulmonary resuscitation with 100% FiO2 and high PEEP was started and the patient was revived successfully. Post resuscitation she was shifted to Intensive care unit (ICU) on high inotropic support. In ICU she was observed to be pale. Her haemoglobin in ABG was found to be 5.4 g%. Bedside ultrasonography revealed haemoperitoneum. Contrast computerised tomography of chest and abdomen was done which showed hepatic artery branch bleed. Glue embolisation of the ruptured artery was undertaken immediately. Subsequently she made uneventful recovery with no neurological deficit and was discharged in a stable condition. Conclusion: High index of suspicion of arterial air embolism is required during neurointerventional procedures. Its prompt diagnosis and appropriate management are needed to avoid major permanent neurological deficits and mortality.