Air emboli during neuroendovascular procedure treated with hyperbaric oxygen therapy

Air embolism is a rare complication of endovascular procedures with hyperbaric oxygen therapy (HBOT) as a potential treatment. We report a male patient in his 40s presented to the emergency department with the following fluctuating symptoms: headache, aphasia, bilateral arm and hand weakness, numbness and blurry vision. Medical history included remote vertebral artery dissection, hypertension and tobacco use. Initial head CT was normal; CT angiogram revealed bilateral internal carotid artery dissections with significant stenosis. He was taken for emergent carotid intervention. During the intervention, the patient developed agitation, bradycardia and respiratory distress, necessitating intubation. Dyna CT revealed air emboli. HBOT was initiated, leading to complete resolution of air emboli and small haemorrhages after one session. Post-treatment, the patient showed neurological improvement, was extubated and later discharged with mild residual aphasia and dysarthria. This case underscores air emboli as a rare complication in the neurointerventional suite and highlights HBOT as a feasible treatment.