Carotid Session to Focus on Asymptomatic Disease, Pivotal Trials

 

A common clinical challenge encountered by vascular surgeons – what to do with asymptomatic carotid artery disease – will be a main focus of the Tuesday afternoon session, “New Key Developments in the Management of Patients with Carotid Disease.”

“Overall, this session will be a look at mostly asymptomatic carotid stenosis, also with some presentations from experts in the field on how to interpret the long-term results of all these trials and incorporate them into your clinical practice. There should be a lot of excitement about this session in light of recent CMS decisions to reimburse for asymptomatic carotid stenosis” in patients who are at high risk for surgery. “That’s a big leap forward,” said moderator Dr. L. Nelson Hopkins of the State University of New York, Buffalo.

“We are going to learn the latest about what’s new in asymptomatic carotid stenosis in terms of diagnosis and treatment. With asymptomatic disease, the question is whether to operate and how to do it. This session will help guide us. We’ll see data on the positive and negative side for treatment, which will help us understand when these procedures are indicated,” he said.

The topic of stenting vs. medical therapy will be the topic of two debates. Dr. Kenneth Rosenfield of Harvard Medical School, Boston, will defend the ACT-1 trial, which found that stenting was noninferior to endarterectomy for up to 5 years in asymptomatic patients with severe stenosis; he was lead investigator. Dr. Anne Abbott of Monash University in Melbourne will counter that medical therapy remains the best option.

In another debate, Dr. Thomas G. Brott of the Mayo Clinic in Jacksonville, Fla., the lead investigator on the CREST trial, will argue that 10-year results prove that stenting and endarterectomy are equivalent for both symptomatic and asymptomatic disease; Dr. J. David Spence, of Western University in London, Ontario, will counter that the data can be interpreted in other ways, and that there is a low rate of occlusion and stroke when high-grade asymptomatic stenosis is treated with best medical therapy.

Dr. Andrew Nicolaides of the Imperial College, London, will also share thoughts on identifying asymptomatic patients who benefit from invasive treatment, and Dr. Bruce Perler of Johns Hopkins University, Baltimore, will argue that endarterectomy is the best option.

The session isn’t limited solely to asymptomatic carotid disease. Dr. James May from the University of Sydney is set to share tips and insights about endovascular repair of saccular aneurysms of the extracranial internal carotid. Recent developments have made this repair safer, but fusiform aneurysms remain a challenge. “There’s going to be information about how to treat these lesions with newer technology,” Dr. Hopkins said.

Session 5:
New Key Developments in the Management of Patients with Carotid Disease
Tuesday,1:00 p.m –2:42 p.m.

Grand Ballroom East, 3rd Floor

 

A common clinical challenge encountered by vascular surgeons – what to do with asymptomatic carotid artery disease – will be a main focus of the Tuesday afternoon session, “New Key Developments in the Management of Patients with Carotid Disease.”

“Overall, this session will be a look at mostly asymptomatic carotid stenosis, also with some presentations from experts in the field on how to interpret the long-term results of all these trials and incorporate them into your clinical practice. There should be a lot of excitement about this session in light of recent CMS decisions to reimburse for asymptomatic carotid stenosis” in patients who are at high risk for surgery. “That’s a big leap forward,” said moderator Dr. L. Nelson Hopkins of the State University of New York, Buffalo.

“We are going to learn the latest about what’s new in asymptomatic carotid stenosis in terms of diagnosis and treatment. With asymptomatic disease, the question is whether to operate and how to do it. This session will help guide us. We’ll see data on the positive and negative side for treatment, which will help us understand when these procedures are indicated,” he said.

The topic of stenting vs. medical therapy will be the topic of two debates. Dr. Kenneth Rosenfield of Harvard Medical School, Boston, will defend the ACT-1 trial, which found that stenting was noninferior to endarterectomy for up to 5 years in asymptomatic patients with severe stenosis; he was lead investigator. Dr. Anne Abbott of Monash University in Melbourne will counter that medical therapy remains the best option.

In another debate, Dr. Thomas G. Brott of the Mayo Clinic in Jacksonville, Fla., the lead investigator on the CREST trial, will argue that 10-year results prove that stenting and endarterectomy are equivalent for both symptomatic and asymptomatic disease; Dr. J. David Spence, of Western University in London, Ontario, will counter that the data can be interpreted in other ways, and that there is a low rate of occlusion and stroke when high-grade asymptomatic stenosis is treated with best medical therapy.

Dr. Andrew Nicolaides of the Imperial College, London, will also share thoughts on identifying asymptomatic patients who benefit from invasive treatment, and Dr. Bruce Perler of Johns Hopkins University, Baltimore, will argue that endarterectomy is the best option.

The session isn’t limited solely to asymptomatic carotid disease. Dr. James May from the University of Sydney is set to share tips and insights about endovascular repair of saccular aneurysms of the extracranial internal carotid. Recent developments have made this repair safer, but fusiform aneurysms remain a challenge. “There’s going to be information about how to treat these lesions with newer technology,” Dr. Hopkins said.

Session 5:
New Key Developments in the Management of Patients with Carotid Disease
Tuesday,1:00 p.m –2:42 p.m.

Grand Ballroom East, 3rd Floor

 

A common clinical challenge encountered by vascular surgeons – what to do with asymptomatic carotid artery disease – will be a main focus of the Tuesday afternoon session, “New Key Developments in the Management of Patients with Carotid Disease.”

“Overall, this session will be a look at mostly asymptomatic carotid stenosis, also with some presentations from experts in the field on how to interpret the long-term results of all these trials and incorporate them into your clinical practice. There should be a lot of excitement about this session in light of recent CMS decisions to reimburse for asymptomatic carotid stenosis” in patients who are at high risk for surgery. “That’s a big leap forward,” said moderator Dr. L. Nelson Hopkins of the State University of New York, Buffalo.

“We are going to learn the latest about what’s new in asymptomatic carotid stenosis in terms of diagnosis and treatment. With asymptomatic disease, the question is whether to operate and how to do it. This session will help guide us. We’ll see data on the positive and negative side for treatment, which will help us understand when these procedures are indicated,” he said.

The topic of stenting vs. medical therapy will be the topic of two debates. Dr. Kenneth Rosenfield of Harvard Medical School, Boston, will defend the ACT-1 trial, which found that stenting was noninferior to endarterectomy for up to 5 years in asymptomatic patients with severe stenosis; he was lead investigator. Dr. Anne Abbott of Monash University in Melbourne will counter that medical therapy remains the best option.

In another debate, Dr. Thomas G. Brott of the Mayo Clinic in Jacksonville, Fla., the lead investigator on the CREST trial, will argue that 10-year results prove that stenting and endarterectomy are equivalent for both symptomatic and asymptomatic disease; Dr. J. David Spence, of Western University in London, Ontario, will counter that the data can be interpreted in other ways, and that there is a low rate of occlusion and stroke when high-grade asymptomatic stenosis is treated with best medical therapy.

Dr. Andrew Nicolaides of the Imperial College, London, will also share thoughts on identifying asymptomatic patients who benefit from invasive treatment, and Dr. Bruce Perler of Johns Hopkins University, Baltimore, will argue that endarterectomy is the best option.

The session isn’t limited solely to asymptomatic carotid disease. Dr. James May from the University of Sydney is set to share tips and insights about endovascular repair of saccular aneurysms of the extracranial internal carotid. Recent developments have made this repair safer, but fusiform aneurysms remain a challenge. “There’s going to be information about how to treat these lesions with newer technology,” Dr. Hopkins said.

Session 5:
New Key Developments in the Management of Patients with Carotid Disease
Tuesday,1:00 p.m –2:42 p.m.

Grand Ballroom East, 3rd Floor