Arterial Gas Embolism During Mitral Transcatheter Edge-to-Edge Repair: Prevention, Management, and Treatment: Case Report and Review of the Literature.

Arterial gas embolism (AGE) during mitral transcatheter edge-to-edge repair (m-TEER) is a serious event that may lead to catastrophic consequences. Careful preparation and inspection of the device is mandatory, and it is usually performed through a series of standardized steps. However, AGE may come from "hidden" parts of the device. We present the first described case of AGE-related stroke during MitraClip procedure due to a faulty clip introducer, highlighting the importance of the additional inspection of this given-for-granted portion of the device. Hyperbaric oxygen therapy led to complete patient recovery, although performed more than 18 h after the event, leaving place to the benefits of a successful m-TEER procedure. We reviewed the literature and described all the possible sources of AGE during m-TEER with MitraClip, and the intra and postprocedural management of AGE. In particular, hyperbaric oxygen remains the gold-standard treatment for AGE, and it is effective even when performed outside commonly considered time windows of efficacy for ischemic injuries.