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2	PCI Complications
3	"Little attention has been given..." Little attention has been given to coronary air embolism complicating PCI. It’s devastating, sometimes...
4	Case Review Patient, Male，71 years old。Peroxymal Chest pain for 1 year, symptom worsen 10 days Risk factors：Smoking for 40 years，20/day. Blood glucose and lipid normal. ECG before procedure
5	Left coronary angiogram
6	Right coronary angiogram
7	After air thrombus, patient suffered from chest pain, and ECG show inferior ST elevation
8	Catheter deep insertion, suck back air and inject 10 ml blood
9	Patient’s symptom resolved in 3 minutes, RCA angiogram again
10	"The occurrence rate of air..." The occurrence rate of air thrombus during coronary intervention:     Total:0.27%        Angiogram:0.1-0.3%;        PCI:0.84%
11	Mechanism of air embolism during PCI 1. Incomplete aspiration of guiding catheter upon introduction into the vasculature 2. Balloon leakage or rupture 3. Prolonged negative suction of self-venting balloon catheters left outside the patient 4. Introduction of balloon catheters into the guiding catheters 5. Removal of balloon catheters from deeply seated guiding catheter 6. Structural failure of catheter
12	The recognition of air thrombus during PCI 1. The patient abruptly complains chest pain or discomfort 2. The typical appearance of air in coronary circulation during contrast injection is a leading edge of contrast media abruptly stopping, with a hazy appearance pulsating back and forth on a meniscus of air
13	Clinical manifestation
14	Management of symptomatic coronary air embolism  (1) 100% oxygen by face mask  (2) Analgesics  (3) Monitor and treat arrhythmias  (4) Circulature support with pressors and intra-aortic balloon pump counterpulsation as necessary  (5) Aspiration, forceful injection of saline or contrast  (6) Emergency CABG
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