The Journal of cardiovascular surgery · 2026
Operative time and outcome after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis: a retrospective multicenter cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Tabac Radu, Lisii Corneliu, Ruckert Mareike, Linder Carlotta, Cebotari Igor, Kleinschmidt Daniel, Nentwig Jessica, Schröder Marie, Taheripour Shervin, Debus Eike S, Grundmann Reinhart T
Аннотация
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.
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.