Carotid artery disease is a common illness that can pose a significant risk if left untreated. Treatment via carotid endarterectomy (CEA) or carotid artery stenting (CAS) can also lead to complications. Given the risk of adverse events related to treating, or failing to treat, carotid artery disease, this is a possible area for litigation. The aim of this review is to provide an overview of the medicolegal factors involved in treating patients suffering carotid artery disease and to compare litigation related to CEA and CAS.
Three large legal databases were used to search for jury verdicts and settlements in cases related to untreated carotid artery disease, CEA, and CAS. Search terms included “endarterectomy,” “medical malpractice,” “carotid,” “stenosis,” “stenting,” “stent,” and combinations of those words. Three types of cases were considered relevant: 1) cases in which the primary allegation was negligence performing a CEA or perioperative care (CEA-related cases); 2) cases in which the primary allegation was negligence performing a CAS or perioperative care (CAS-related cases); and 3) cases in which the plaintiff alleged that a CEA or CAS should have been performed (failure-to-treat [FTT] cases).
One hundred fifty-four CEA-related cases, 3 CAS-related cases, and 67 FTT cases were identified. Cases resulted in 133 verdicts for the defense (59%), 64 settlements (29%), and 27 plaintiff verdicts (12%). The average payout in cases that were settled outside of court was $1,097,430 and the average payout in cases that went to trial and resulted in a plaintiff verdict was $2,438,253. Common allegations included a failure to diagnose and treat carotid artery disease in a timely manner, treating with inappropriate indications, procedural error, negligent postprocedural management, and lack of informed consent. Allegations of a failure to timely treat known carotid artery disease were likely to lead to a payout (60% of cases involved a payout). Allegations of procedural error, specifically where the resultant injury was nerve injury, were relatively less likely to lead to a payout (28% of cases involved a payout).
Both diagnosing and treating carotid artery disease has serious medicolegal implications and risks. In cases resulting in a plaintiff verdict, the payouts were significantly higher than cases resolved outside the courtroom. Knowledge of common allegations in diagnosing and treating carotid artery disease as well as performing CEA and CAS may benefit neurosurgeons. The lack of CAS-related litigation suggests these procedures may entail a lower risk of litigation compared to CEA, even accounting for the difference in the frequency of both procedures.
ABBREVIATIONSCAS = carotid artery stenting; CEA = carotid endarterectomy; FTT = failure to treat; MI = myocardial infarction.
DurandWM, EltoraiAEM, ShantharamG, DePasseJM, KurisEO, HerseyAE, : Medical malpractice claims following incidental durotomy due to spinal surgery. 43:940–945, 201810.1097/BRS.000000000000246929200173)| false
EderleJDobsonJFeatherstoneRLBonatiLHvan der WorpHBde BorstGJ: Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet375:985–9972010
EderleJ, DobsonJ, FeatherstoneRL, BonatiLH, van der WorpHB, de BorstGJ, : Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. 375:985–997, 20102018923910.1016/S0140-6736(10)60239-5)| false
GuptaR, GriessenauerCJ, MooreJM, AdeebN, PatelAS, OgilvyCS, : An analysis of malpractice litigation related to the management of brain aneurysms. 127:1077–1083, 201710.3171/2016.9.JNS16112428009242)| false
HalmEA, TuhrimS, WangJJ, RockmanC, RilesTS, ChassinMR: Risk factors for perioperative death and stroke after carotid endarterectomy: results of the New York Carotid Artery Surgery Study. 40:221–229, 200910.1161/STROKEAHA.108.52478518948605)| false
RinglebPAAllenbergJBrückmannHEcksteinHHFraedrichGHartmannM: 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet368:1239–12472006
RinglebPA, AllenbergJ, BrückmannH, EcksteinHH, FraedrichG, HartmannM, : 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. 368:1239–1247, 200610.1016/S0140-6736(06)69122-817027729)| false
RosenfieldK, MatsumuraJS, ChaturvediS, RilesT, AnselGM, MetzgerDC, : Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. 374:1011–1020, 201610.1056/NEJMoa151570626886419)| false
RovitRLSimonASDrewJMuraliRRobbJ: Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. J Neurosurg106:1108–11142007
RovitRL, SimonAS, DrewJ, MuraliR, RobbJ: Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. 106:1108–1114, 20071756419110.3171/jns.2007.106.6.1108)| false
SeaburySA, ChandraA, LakdawallaDN, JenaAB: On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. 32:111–119, 20132329727810.1377/hlthaff.2012.0967)| false
SiddiqFAdilMMMalikAAQureshiMHQureshiAI: Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial results on the performance of carotid artery stent placement and carotid endarterectomy in the United States. Neurosurgery77:726–7322015
SiddiqF, AdilMM, MalikAA, QureshiMH, QureshiAI: Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial results on the performance of carotid artery stent placement and carotid endarterectomy in the United States. 77:726–732, 20152630863310.1227/NEU.0000000000000905)| false