CX 31- Alison Halliday vs. Ross Naylor on carotid interventions


On Monday 6 April at the CX Symposium, Ross Naylor, University of Leicester, UK, will debate Alison Halliday, St George’s Hospital Medical School, London, UK, on the issue of whether medical therapy arms are necessary in trials exploring stroke risk reduction from carotid endarterectomy.

Halliday will argue that a separate medical therapy arm would be redundant in the majority of trials concerning the management of asymptomatic carotid stenosis. She will assert that the trials already undertaken represent trials of endarterectomy against a background of intensive medical management.

“Although medical therapy has improved since initial recruitment into the trials of carotid surgery,” said Halliday, “the potential benefits in terms of stroke prevention should not be overestimated.”

Halliday is also concerned that trial results have been misinterpreted, leading to an underestimation of the benefit of early endarterectomy.
Naylor will seek to demonstrate that, despite the very best efforts of surgeons and interventionists, any strategy aimed at delivering carotid endarterectomy or carotid angioplasty with stenting to patients with asymptomatic carotid disease will have relatively little impact upon the overall burden of stroke in the community.

Naylor is concerned that justification for early intervention in asymptomatic patients raises the spectre of intentional overtreatment, as it has been observed that carotid endarterectomy can be a considerable income generator for surgeons.

Carotid imaging

Carotid disease is a hugely significant indication globally “being responsible for around half of the 5.5 million stroke deaths worldwide every year” and imaging of the carotid bifurcation is a crucial element in its treatment. At this year’s CX Symposium, Rob Morgan of St George’s Hospital, London, UK, will present a review of the current state of imaging in this indication.

Antithrombotic strategies
Afshin Assadian, Department of General and Vascular Surgery, Wilhelminenspital Vienna, Austria, will highlight the importance of sufficient and aggressive antithrombotic strategies.

He will explore the unpredictability of perioperative unfractionated heparin, the possible superiority of low-molecular-weight heparin, the limited benefits of preoperative acetyl salicylic acid, clopidogrel, dual-antiplatelet therapies, and oral anticoagulation. Assadian will also touch on the future of antithrombotic therapies.


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