Caught in the Air: Symptomatic Cerebral Arterial Air Embolism during Endovascular Flow Diversion

Abstract

Symptomatic cerebral arterial air embolism (CAAE) is a rare complication of endovascular procedures. Early diagnosis and management are critical to alleviate neurological deficits and to prevent mortality. Neurointerventionists should take prompt action on suspicion of air embolism to prevent catastrophic consequences. Hyperbaric oxygen therapy is the treatment of choice, however, in its nonavailability, multiple measures can be taken immediately to minimize complications and to promote dissolution of air emboli. We report a case of CAAE during endovascular treatment of unruptured left ophthalmic internal carotid artery aneurysm using a flow diverter, which was actively managed with a good outcome.

Keywords

air embolism - cerebral arterial air embolism - endovascular flow diversion

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Patient's Consent

Informed patient consent was obtained for this study.

Publication History

Article published online:
11 June 2025

• References

• 1 Gupta R, Vora N, Thomas A. et al. Symptomatic cerebral air embolism during neuro-angiographic procedures: incidence and problem avoidance. Neurocrit Care 2007; 7 (03) 241-246
• 2 Voorhies RM, Fraser RA. Cerebral air embolism occurring at angiography and diagnosed by computerized tomography. Case report. J Neurosurg 1984; 60 (01) 177-178
• 3 McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: diagnosis, clinical management and outcomes. Diagnostics (Basel) 2017; 7 (01) E5
• 4 Tan LA, Keigher KM, Lopes DK. Symptomatic cerebral air embolism during stent-assisted coiling of an unruptured middle cerebral artery aneurysm: intraoperative diagnosis and management of a rare complication. J Cerebrovasc Endovasc Neurosurg 2014; 16 (02) 93-97
• 5 Suri V, Gupta R, Sharma G, Suri K. An unusual cause of ischemic stroke - cerebral air embolism. Ann Indian Acad Neurol 2014; 17 (01) 89-91
• 6 Cruz AS, Khattar NK, Weiner GM, Aljuboori ZS, Schirmer CM. Preventing air microembolism in cerebral angiography: a JNIS fellow's perspective. J Neurointerv Surg 2024; 16 (04) 331-332
• 7 Sayama T, Mitani M, Inamura T, Yagi H, Fukui M. Normal diffusion-weighted imaging in cerebral air embolism complicating angiography. Neuroradiology 2000; 42 (03) 192-194
• 8 Surve RM, Reddy KRM, Bansal S, Ramalingaiah A. Massive cerebral air embolism during stent-assisted coiling of internal carotid artery aneurysm. Neurol India 2013; 61 (01) 95-97
• 9 Segan L, Permezel F, Ch'ng W. et al. Cerebral arterial gas embolism from attempted mechanical thrombectomy: recovery following hyperbaric oxygen therapy. Pract Neurol 2018; 18 (02) 134-136
• 10 Belton PJ, Nanda A, Alqadri SL. et al. Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration. BMJ Case Rep 2016; 2016: bcr2016012535
• 11 Lau L, London K. Cortical blindness and altered mental status following routine hemodialysis, a case of iatrogenic cerebral air embolism. Case Rep Emerg Med 2018; 2018: 9496818
• 12 Kalani MYS, Park MS, Kilburg C, Taussky P. Cerebral air embolism treated with endovascular flow reversal and suction aspiration. Interdiscip Neurosurg 2017; 10: 17-19
• 13 Yang TK. Spontaneous absorption of cerebral air embolus developed accidentally during an intra-arterial procedure. J Cerebrovasc Endovasc Neurosurg 2016; 18 (04) 391-395