Coronary Air Embolism During Coronary Angiography : A Systematic Review.

Coronary air embolism (CARE) is a rare complication during transluminal coronary angiography or angioplasty and is almost always iatrogenic. CARE can cause significant morbidity and mortality as shown in animal studies. CARE is known to cause acute chest pain, hypotension, bradycardia, ST-segment elevation myocardial infarction (STEMI), and death. Multiple isolated case reports of CARE have been reported. We here present a systematic review of cases of CARE during transluminal coronary angiography or angioplasty. Multiple databases were searched to identify cases, the cases were thoroughly read and findings were tabulated. Our analysis revealed that CARE most often resulted in chest pain or loss of consciousness. Most of the patients developed bradycardia and hypotension. STEMI was the most common electrocardiography (EKG) finding and discrete vessel cut off was the most common angiographic finding. Coronary angiography technique including avoidance of air in the angiogram equipments by education of physicians and paramedical staff new to coronary angiography or angioplasty plays a vital role in prevention of CARE. Physicians should be aware of CARE as one of the cause of chest pain, hypotension, bradycardia, STEMI and arrhythmias during transluminal coronary angiography or angioplasty.