Development of a novel technique with a pigtail catheter and high-pressure injector for coronary postmortem computed tomography angiography

Abstract

ABSTRACT Coronary post-mortem computed tomography angiography (coronary PMCTA) is a non-invasive method to evaluate the coronary artery in the forensic practice. A traditional method is to insert a urinary catheter through the carotid artery. In this study, we performed the coronary PMCTA by inserting a pigtail catheter through the femoral artery and connecting the catheter to a high-pressure syringe. We report the efficacy of this technique and factors influencing its performance, including the position of the catheter tip, aortic gas, high-pressure injector, and location of skin puncture. A total of 14 cadavers were included in our study. Two cadavers with coronary artery occlusions were identified in the PMCTA, which were confirmed by the autopsy reports. In addition, we found that adequate imaging of all the branches of the left and right coronary arteries could be achieved when the catheter tip was located in the ascending aorta around the aortic valve. Gas in the aorta could affect the image acquisitions, which could be avoided by priming the catheter with normal saline and changing the cadaver positions. The femoral artery insertion of the pigtail catheter with a high-pressure injector could achieve satisfactory images without causing obvious disfiguration of the cadavers.