Vascular clips for primary closure in classic carotid endarterectomy: A 5-year exploratory retrospective cohort study

ObjectiveTo evaluate the intraoperative efficiency and long-term outcomes of clip-assisted primary closure versus conventional suturing in classic carotid endarterectomy (CEA).MethodsThis single-center retrospective cohort study included 46 classic CEA procedures in 45 patients treated between 2013 and 2019. Procedures were divided into a clip group (n = 15) and a suture group (n = 31). The primary endpoints were carotid clamping time and intraoperative blood loss. Secondary endpoints included operative time, postoperative drainage volume, perioperative stroke, long-term stroke incidence, and all-cause mortality.ResultsThe clip group had a significantly shorter carotid clamping time than the suture group (12.67 ± 5.74 min vs. 18.26 ± 7.84 min, P = 0.048) and significantly lower intraoperative blood loss (38.00 ± 18.97 mL vs. 56.77 ± 23.01 mL, P = 0.010). No statistically significant between-group differences were observed in total operative time, postoperative drainage volume, perioperative stroke, long-term stroke incidence, or all-cause mortality.ConclusionsIn this exploratory retrospective cohort study, clip-assisted primary closure during classic CEA was associated with shorter carotid clamping time and lower intraoperative blood loss than conventional suturing. No signal of increased perioperative or long-term adverse outcomes was detected; however, the study was not powered to establish equivalence or non-inferiority for rare safety endpoints. These findings support the technical feasibility of clip-assisted primary closure in selected patients, but larger prospective studies are needed to further evaluate its safety and long-term effectiveness.