This case involves a male patient who suffered a devastating ischemic stroke shortly after undergoing an aortic stent repair for an aortic arch aneurysm. A covered stent was placed after aortic stenosis and a pseudoaneurysm were found. Subsequently, the stent fractured, and a piece lodged in the patient’s right leg. It was recommended that stainless steel stents be placed inside the fractured stent to hold it in place. After the procedure was completed, the patient was slow to emerge after extubation, and a nurse noted right hemiparesis. The neurology team was called to his bedside, and a CT scan revealed a cerebral artery infarction with possible anterior cerebral artery thrombus. The next day, he was discharged to another medical center after further scans demonstrated evolution of the cerebral artery infarction and anterior cerebral artery infarctions, as well as an occlusion of the right internal carotid artery. The patient suffered serious cognitive and neurological deficits from his stroke, and will require a lifetime of ongoing care.
Question(s) For Expert Witness
- 1. Do you routinely treat patients like the one described in this case?
- 2. Based on the summary, is it possible that this patient might have had a better outcome had the care rendered been different?
Expert Witness Response E-015592
I am a board certified pediatric cardiologist who is specifically trained in invasive and interventional cardiology. I have performed 1500+ procedures on infants and children and adults with congenital heart disease and I have worked at large-volume medical centers for the duration of my career. I commonly treat patients presenting similar complications and I personally perform interventions on children and adolescents with this type of heart disease. My opinion is that it is certainly possible that the patient could have had a better outcome had different care been rendered.
Expert Witness Response E-015562
I am head of Interventional Pediatrics and Congenital Cardiology at a top-ranking University, and I am internationally known for my research and clinical work. I routinely perform this procedure and it is definitely possible that if the care rendered had been different, there would have been a better outcome. Some factors to take into consideration; it will depend on exactly how well the initial stent was deployed, what the ECHO looked like before and after both procedures (function and stent gradient), what anticoagulation was used for the case, and what the hemodynamics were before and after the initial and final procedure.