22. European Stroke Conference 567 Acute stroke: emergency management, stroke units and complications Non-accidental Arterial Cerebral Air Embolism: A 10-year stroke center experience S. Tsetsou1, E. Eeckhout2, S.D. Qanadli3, Y. Lachenal4, F. Vingerhoets5, P. Michel6 CHUV, LAUSANNE, SWITZERLAND1, CHUV, LAUSANNE, SWITZERLAND2, CHUV, LAUSANNE, SWITZERLAND3, CHUV, LAUSANNE, SWITZERLAND4, CHUV, LAUSANNE, SWITZERLAND5, CHUV, LAUSANNE, SWITZERLAND6 Background and Purpose: Non-accidental arterial cerebral air embolism (CAE) is an uncommon, usually iatrogenic cause of cerebral ischemic events (CIE). We aim to explore the incidence, causes and treatment of CAE-related CIE. Methods: We retrospectively reviewed all CAE-related CIE in a single academic center over a 10- year period. We excluded potential CAE from diving, traumatism and surgery. Results: Among 4’557 consecutive patients, five fulfilled the inclusion criteria (incidence of 0.1%). In three of them, air embolism was paradoxical and related to a patent foramen ovale: two after the venous injection of microbubbles during diagnostic echocardiography and one during central venous catheter hemodialysis. In one patient, recurrent CAEs and acute coronary syndromes were related to air entry in the pulmonary veins from pulmonary arteriovenous malformations and in another from needle lung biopsy. Hyperbaric oxygen therapy in two patients led to rapid recovery. Conclusions: Non-accidental CAE should be suspected in patients with acute focal neurological deficits in the setting of right-to-left shunts and iatrogenic manipulations of the vascular system. It is a rare, preventable, and treatable condition. 644 © 2013 S. Karger AG, Basel Scientific Programme Clinical and radiological information Patient 1 2 3 4 5 Vascular risk factors Hypertension Hypercholesterolemia Ex-smoker Diabetes type II Hypertension Hypercholesterolemia Smoker Diabetes type II Hypertension Hypercholesterolemia Clinical diagnosis related to CAE Left MCA stroke Multifocal TIA Right MCA stroke Multiple TIAs, strokes, ACS, sei-zures and cardiore-spiratory arrest Bilateral MCA stroke NIHSS (acute à 24hours à 7days) 11 à 5 à 1 4 à 0 à 0 23 à 23 à 11 13 à 13 à 5 (most severe epi-sode) 2 à 1 à 0 Cause of air emboli Diagnostic injection of bubbles during TTE Diagnostic injec-tion of bubbles during TTE Dialysis through CVC with presumed air em-boli through PFO Air entry directly into PAVMs Air entry into pulmo-nary veins during lung biopsy Right-to-left shunt Incompletely closed PFO PFO with mas-sive shunt PFO with moderate shunt PAVMs with mas-sive shunt. No PFO PFO with minimal shunt Acute neu-ro- imaging Median delay:150 min., range 30 min. to 9 hours CT: chronic cerebel-lar stroke MRI: normal CT: air bubbles in right MCA cortex CTP: right MCA hy-poperfusion CT after most severe stroke: nor-mal. CTP: left MCA hypoperfusion CT after cardio-respiratory arrest: air bubbles in left MCA cortex CT: chronic lacunes Subacute neuroimag-ing MRI: chronic cerebel-lar stroke - CT: anterior right MCA edema MRI: bihemispher-ic ischemic lesions MRI: bihemispheric ischemic lesions Treatment Acute HOT Acute HOT PFO closure Embolization of PAVMs - 3 months mRS 1 0 6 2 1 NIHSS= National Institute of Health Stroke Scale; mRS = modified Rankin scale.
Karger_ESC London_2013
To see the actual publication please follow the link above