The spectrum of symptomatic coronary air embolism during balloon angioplasty: causes, consequences, and management.

PTCA is a widely used method of myocardial revascularization. Although complications of this procedure have been characterized, air emboli to the coronary vasculature have rarely been reported and their appropriate management is uncertain. We report six cases of symptomatic coronary air emboli occurring during PTCA. The possible mechanisms of the introduction of air during PTCA include incomplete aspiration of guiding catheters, balloon rupture, insinuation of air with balloon catheter introduction or withdrawal; structural failures of the equipment, and constant negative suction of selfventing catheters left outside the body. Symptomatic responses range from mild angina to full cardiac arrest and tend to resolve spontaneously in 5 to 10 minutes. Treatment is aimed at supporting the patient for this brief period, and consists of 100% inspired oxygen, analgesics, arrhythmic therapy if needed, and pressor and balloon pump support as required. Greater awareness of the causes, prevention, and therapy of coronary air emboli will lead to the safer practice of PTCA.