A carotid endarterectomy is a serious medical procedure designed to reduce the risk of a stroke for patients with atherosclerotic debris (plaque) that can block the flow of blood.   It is a routinely performed yet significant procedure that usually requires a hospital stay.

Arterial plaque of concern is often found from carotid Doppler studies and/or an echocardiogram.  The purpose of an endarterectomy is to remove the plaque that can block the flow of blood.  The procedure is seemingly simple.  The doctor goes in through the neck and exposes the artery of concern and then opens the artery and removes the plaque.  The surgeon may have to insert a tube to redirect the blood around the artery being repaired.

Again, this is serious surgery and it comes with risks.  Even with the best surgeon in the world, this is not a risk free procedure. But medical care can help to reduce those risks. One reoccurring malpractice case involving this procedure is damaging critical nerves in the neck. In particular, surgeons performing an endarterectomy should identify the hypoglossal nerve and retract it to prevent cutting the nerve.  If this is not properly done, the patient may have tongue deviation or dysphagia (an awful condition that may make swallowing difficult or painful). 

You would think that failing to identify and protect the hypoglossal nerve would lead the doctor to concede medical malpractice.  Yet these cases are routinely defended, even those that appear to be slam dunk malpractice lawsuits for cutting the hypoglossal nerve and causing injury to the patient. 

Doctors’ medical malpractice lawyers’ typically argue that injury to the hypoglossal and other nerves are a known risk to an endarterectomy.  It is true. There are risks to almost anything.  It is a known risk that you might get hit by a drunk at a bar.  But that does not absolve the drunk of responsibility.

Another common defense is the “patient had unusual anatomy.”  This is a common defense in surgery cases and it can be effective: how do you argue your internal anatomy is perfectly normal?  These are slightly more saleable defenses in some cases but usually it is a reflex response for surgeons being questioned even if, there is nothing to indicate the patient had an unusual anatomy (and no one else in the operating room remembers any suggestion that there was a problem with the patient’s anatomy).  Moreover, there is a good rule: don’t cut unless you know what you are cutting.