Iatrogenic air embolism: influence of air bubble size on cerebral infarctions in an experimental in vivo and numerical simulation model

Medientyp: E-Artikel

Titel: Iatrogenic air embolism : influence of air bubble size on cerebral infarctions in an experimental in vivo and numerical simulation model

Beteiligte: Schaefer, Tabea [Verfasser:in]; Greive, Svenja [Verfasser:in]; Bierwisch, Claas [Verfasser:in]; Mohseni-Mofidi, Shoya [Verfasser:in]; Heiland, Sabine [Verfasser:in]; Kramer, Martin [Verfasser:in]; Möhlenbruch, Markus Alfred [Verfasser:in]; Bendszus, Martin [Verfasser:in]; Vollherbst, Dominik [Verfasser:in]

Erschienen: 2023

Sprache: Englisch

DOI: 10.1136/jnis-2023-020739

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Schlagwörter: Angiography ; Catheter ; Complication ; Intervention ; Stroke

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Beschreibung: Background Cerebral infarctions resulting from iatrogenic air embolism (AE), mainly caused by small air bubbles, are a well-known and often overlooked event in endovascular interventions. Despite their significance, the underlying pathophysiology remains largely unclear. - Methods In 24 rats, AEs were induced using a microcatheter, positioned in the carotid artery via femoral access. Rats were divided into two study groups, based on the size of the bubbles (85 and 120 µm) and two sub-groups, differing in air volume (0.39 and 0.64 µl). Ultra-high-field magnetic resonance imaging (MRI) was performed 1.5 hours after intervention. MRI findings including the number, single volume and total volume of the infarctions were assessed. A software-based numerical simulation was performed to qualitatively assess the microvascular pathomechanisms. - Results In the study groups 22 of 24 rats (92%) revealed cerebral infarctions. The number of infarctions per rat was higher for the smaller bubbles, for the lower (medians: 5 vs 3; p=0.049) and higher air volume sub-groups (medians: 6 vs 4; p=0.012). Correspondingly, total infarction volume was higher for the smaller bubbles (1.67 vs 0.5 mm³; p=0.042). Simulations confirmed the results of the experiments and suggested that fusion of microbubbles to larger bubbles is the underlying pathomechanism of vascular occlusions. - Conclusion In iatrogenic AE, the size of the bubbles can have a major impact on the number and total volume of cerebral infarctions. These findings can help to better understand the pathophysiology of this frequent, often underestimated adverse event in endovascular interventions.

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