This case involves a sixty-five-year-old female patient with a past medical history of coronary artery disease. This patient presented to her primary care physician with exertional chest pain, dizziness, SOB, and palpitations. A cardiologist was consulted and the decision for angioplasty was made. While in the catheter lab, there was a break in the guide-wire and the tip embolized distally in the left anterior descending artery, which resulted in a small inferior wall myocardial infarction. The cardiologist determined that retrieval of the guide-wire tip in such a small tortuous vessel off the LAD would cause further damage and decided to leave the tip behind. Post-cardiac catheterization, the patient had multiple episodes of ventricular tachycardia, elevated troponin, chest pain, and admission to the cardiac unit.
Question(s) For Expert Witness
Was this a medical product issue or mistake by the interventional cardiologist?
Expert Witness Response
In this particular case, it seems that the patient who suffered from myocardial ischemia is unrelated to the break of the tip of the guidewire. This is because the patient had an inferior myocardial infarction (MI); if the embolized tip was in the LAD, the patient would have an anterior MI. Thus it would be correct to say that it was a medical device malfunction rather than the interventional cardiologist. It is rare to see guidewire complication during cardiac catheterization and diagnostic coronary angiography (eg, distal embolization leading to myocardial ischemia). However, some of the risks in these cardiac procedure include: in-hospital death (1%), perforation, distal embolization, side branch occlusion, and myocardial ischemia. Other important complications, not due to the doctor but the procedure itself, include acute kidney injury secondary to the contrast used in cardiac catheterization. Therefore, in this case, tip dislodgement is an atypical presentation of this procedure and it is likely due to product malfunction.
About the author
Michael Talve, CEO
Michael Talve stands at the forefront of legal innovation as the CEO and Managing Director of Expert Institute. Under his leadership, the Expert Institute has established itself as a vital player in the legal technology arena, revolutionizing how lawyers connect with world-class experts and access advanced legal technology. Michael's role involves not only steering the company's strategic direction but also ensuring the delivery of unparalleled intelligence and cutting-edge solutions to legal professionals. His work at Expert Institute has been instrumental in enhancing the capabilities of attorneys in case preparation and execution, making a significant impact on the legal industry's approach to expert consultation and technological integration. Michael's vision and execution have positioned the Expert Institute as a key facilitator in the intersection of law and technology.
