Operative time and outcome after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis: a
Radu Tabac1, Corneliu Lisii2, Mareike Ruckert3
1Department of Vascular and Endovascular Surgery, Thüringen-Kliniken Georgius Agricola Saalfeld and Department of Vascular and Endovascular Surgery, Clinic for Visceral, Thoracic and Vascular Surgery, University Hospital of Dresden, Dresden, Germany - radu_tabak@yahoo.com.
Background:
Carotid endarterectomy (CEA) is the standard treatment for asymptomatic and symptomatic carotid stenosis, but the impact of operative duration on outcomes remains unclear. Previous studies suggested longer procedures increase short-term complications. This multicenter study aimed to evaluate the relationship between operative time and perioperative as well as one-year outcomes, considering indication, surgical technique, and center-specific factors.
Methods:
We retrospectively analyzed 1966 patients (70.7% male; 62.1% asymptomatic) undergoing CEA between 2015 and 2023. Of these, 1,560 (79.3%) underwent patch angioplasty and 406 (20.7%) eversion endarterectomy (EEA), under local (N.=918) or general anesthesia (N.=1048). All patients were followed for one year.
Results:
Mean operative time was 99.9±31.8 minutes, longer in men, obese, and symptomatic patients, and varied between centers (69.9-121.6 minutes). EEA was faster than conventional CEA (83.1±26.3 vs. 104.3±31.7 minutes; P<0.001) with similar 30-day major adverse cardiovascular events (MACE) and stroke rates. EEA had lower rates of cranial nerve injury (OR 0.15, 95% CI 0.04-0.52) and early restenosis/occlusion (OR 0.27, 95% CI 0.07-0.97). No differences were observed in long-term MACE, restenosis, or reoperation. Longer operative time correlated with prolonged ICU and hospital stay, and MACE risk increased once operative time exceeded ~200 minutes.
Conclusions:
Operative time alone is not a reliable quality metric. EEA provides a faster procedure than conventional CEA while maintaining comparable short- and long-term outcomes and lower peri-operative morbidity. It is a safe and efficient alternative in selected patients.
