Abstract 219: Cerebral Air Embolism After Coronary Artery Bypass Graft: A Case Report and Systematic Review of Current Literature
Authors: Adachi K. , Hukamdad M. , Raymundo A. , Ali U. , Zamil D. , Yazji I. , Sarva S. , Ezzeldin R. , Ezzeldin M. 
Published: January 2025

Introduction

Cerebral air embolism (CAE) is a rare but serious complication of cardiac procedure, often leading to significant neurological deficits. The study presents a case of CAE after coronary artery bypass graft (CABG) and a systematic review to highlight the incidence, symptom presentation, and outcomes associated with CAE following cardiac surgeries and interventions.

Case Presentation

We present a case of a 71‐year‐old African‐American male with a past medical history of hypertension, hyperlipidemia, high‐degree AV block with a pacemaker, and cerebrovascular accident who presented with a non‐ST segment elevation myocardial infarction. Following a successful CABG, the patient had a normal postoperative neurological exam and was ambulating independently. During a physical therapy session one day after the operation, however, the patient suddenly lost consciousness requiring intubation. CT brain demonstrated diffuse bilateral hemispheric air emboli. CTA head and neck ruled out large vessel occlusion but was concerning for cortical vein embolism. Despite immediate interventions, including Trendelenburg and left lateral decubitus positioning and high‐flow oxygen therapy, the patient developed seizures and progressive neurological deterioration. On postoperative day two, the patient had absent cranial nerve reflexes and an MRI brain revealed anterior and posterior circulation, diffuse bilateral hemispheric ischemic infarcts including bilateral thalami, and brainstem. The patient's condition continued to deteriorate and was transitioned to hospice care.

Method

A systematic review was performed following PRISMA guidelines. The extracted data included diagnostic modalities, procedural factors, and neurological outcomes related to CEA. A descriptive analysis of such variables was performed.

Result

There were 20 articles with 43 patients of whom 27 were male (62.8%). The average age of the patient population was 57.3 (± 20). CAE was diagnosed primarily through clinical suspicion with iatrogenic air bubbles (27.9%) and air visualized on CT (20.9%). Other diagnostic criteria included clinical suspicion with iatrogenic air bubbles (4.7%) and clinical suspicion with air visualized intraprocedural (4.7%). The most common procedures associated with CAE were cardiac ablation (23.3%), CABG (20.9%), valve repair (14.0%), and a repair of cardiac structural anomaly (14.0%). Less common procedures included angiography (2.3%) and cardiac bypass surgery with biventricular assist device placement (2.3%). The presenting neurological symptoms included motor deficit (37.2%), decreased consciousness (20.9%), language deficit (11.6%), visual deficit (2.3%), and coma (2.3%). 12 patients died with a mortality rate of 27.9%.

Conclusion

This case and systematic review highlight the importance of early recognition and intervention in managing CAE, particularly in high‐risk cardiac surgical patients. Given the detrimental neurological outcomes, CAE must be identified as a potential cause of acute stroke following cardiovascular procedures. Timely diagnosis can aid in targeted neuroprotective strategies and tailored surgical interventions to mitigate cerebral injury and improve patient outcomes in this rare but devastating complication.