Operative time and outcome after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis: a retrospective multicenter cohort study.

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.