Percutaneous transluminal angioplasty is a technique widely used to treat stenotic atherosclerotic lesions of the coronary arteries. This technique is currently gaining acceptance for the treatment of cerebral atherosclerotic disease. Autopsy findings of fatal complications of percutaneous transluminal angioplasty of the posterior cerebral circulation have, to our knowledge, not yet been published. We report the case of a patient with severe diffuse atherosclerosis of vertebral and basilar arteries, whose symptoms were not ameliorated with standard medical therapy. Transfemoral percutaneous transluminal angioplasty was performed in an attempt to reestablish blood flow in the posterior cerebral circulation by angioplasty of a severely stenotic basilar artery. The patient suffered a fatal complication during the procedure due to rupture of the basilar artery by the percutaneous transluminal angioplasty guidewire apparatus, leading to massive subarachnoid hemorrhage. We report the clinical and autopsy findings of this case.