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Fast-Track Protocol for Carotid Surgery.

Noemi Baronetto1,2, Stefano Brizzi1, Arianna Pignataro1,2

  • 1Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.

Journal of Clinical Medicine
|June 26, 2025
PubMed
Summary

A new fast-track protocol for carotid endarterectomy (CEA) significantly reduces hospital stay and shows low complication rates. This approach enhances recovery for patients undergoing this common surgical procedure.

Keywords:
carotid endarterectomyenhanced recoveryeversion techniquefast-track protocollocal anesthesia

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Area of Science:

  • Vascular Surgery
  • Surgical Protocols
  • Patient Recovery

Background:

  • Fast-track (FT) protocols aim to minimize surgical impact and improve recovery.
  • Establishing FT protocols for carotid endarterectomy (CEA) is crucial.
  • Carotid stenting offers a less invasive alternative, though its benefits are debated.

Purpose of the Study:

  • To propose and evaluate a fast-track protocol for carotid endarterectomy (CEA).
  • To analyze the clinical outcomes of CEA performed under a fast-track protocol.

Main Methods:

  • Retrospective analysis of 853 patients undergoing CEA for asymptomatic stenosis (Jan 2016-Dec 2024).
  • Protocol included same-day admission, local anesthesia, non-invasive assessments, and selective cervical drainage.
  • Discharge criteria focused on absence of pain, hemodynamic instability, and complications.

Main Results:

  • Mean length of hospital stay was 1.17 days.
  • Low complication rates: 0.4% minor stroke, 0.2% myocardial infarction.
  • Postoperative pain control was adequate in 99.4% of patients (NRS <= 4).

Conclusions:

  • The developed fast-track protocol for elective carotid surgery is associated with a low complication rate.
  • The protocol demonstrates clinical value, warranting further validation via comparative studies.
  • Comparative medico-economic research is recommended for implementing FT protocols in carotid surgery.