Death during percutaneous transluminal coronary angioplasty (PTCA) and themedicolegal aspects

Coronary embolisation is a very rare complication of the clinically widespr ead method of percutaneous transluminal coronary angioplasty (PTCA). The we ll-documented case of a 64-year-old male patient is presented comparing ang iographic and morphological findings. The occluded left anterior descending artery (LAD) was successfully dilated during PTCA. Simultaneously the circ umflex artery showed acute occlusion. The patient fell into cardiac shock a nd died after attempted resuscitation and agonal installation of extracorpo real circulation. The autopsy revealed severe residual stenosis of the prox imal LAD by parietal thrombosis and occlusion of the proximal circumflex ar tery by an unattached intraluminal thrombus (0.8X0.3X0.2 cm) which had been dislocated during PTCA. Autopsy thus confirmed the clinical presumption of coronary embolism and, in addition, disclosed a previously unknown perfora tion of the femoral artery which had occurred during agonal installation of extracorporeal circulation and contributed to death via severe retroperito neal hemorrhage. The case is discussed under the aspects of clinical qualit y control by forensic pathological investigations. (C) 1999 Elsevier Scienc e Ireland Ltd. All rights reserved.