Patient Faces Lowered Quality of Life after Endarterectomy

This case was filed in the aftermath of a left carotid endarterectomy, where the patient never fully recovered from collateral nerve damage that left him with a debilitatingly impacted quality of life. Prior to the procedure, the seventy year-old patient was in relatively good health and had managed a busy auto repair garage, though imaging before his operation had shown moderate narrowing in the carotid artery and additional, mild narrowing in his left subclavian artery. While in post-operative recovery, he began to show signs of neurological deficit, including an inability to move his right upper and lower extremities, and was promptly taken back to the operating room. Despite efforts to repair the nerve damage, he returned from the hospital unable to run his business as he had been assessed as high fall risk, aphasia, and having memory and cognitive deficiencies.

Question(s) For Expert Witness

1. In your experience, what are the indications for performing carotid endarterectomies?

2.Which studies do you utilize in the preoperative work-up, and what is your threshold for operating?

Expert Witness Response E-000056

I have performed almost two thousand carotid endarterectomies and I am well recognized as an expert in the field. The usual indication for carotid endarterectomy in the United States is an asymptomatic high-grade lesion greater than 70%. Symptomatic lesions greater than 50% also require therapy in the majority of patients. I have reviewed cases such as this in the past, and have published extensively on the management of carotid disease.