This medlegal malpractice case involved a improperly performed carotid endarterectomy surgery resulting in permanent brain damage. The radiologist and the surgeon both mistakenly diagnosed the patient with severe carotid artery disease (80% narrowing). The surgeon elected to perform the procedure resulting in a series of mistakes: failure to place a shunt to divert blood to the brain, damage to the carotid artery wall, and complete ligation of the carotid artery. This caused a blood clot and stroke which permanently damaged a large territory of the right side of the brain.
The first departure from the standard of care was performing this procedure on an artery with mild stenosis instead of severe stenosis. Artifacts seen high up on the internal carotid were misinterpreted as severe stenosis due to atherosclerosis.
During the surgery, an arterial clamp and shunt was not used which cut off blood flow to the brain during the duration of the surgery. The artery was then perforated while the surgeon tried to clean disease (that was not present) from the artery wall.
Instead of a performing a external carotid swing operation to preserve blood flow to the brain, both the external carotid artery and the internal carotid artery were ligated and closed.
This lead to a large brain infarct following the surgery and permanent brain damage.