Carotid artery disease (CAD) results from fat and cholesterol deposits known as plaque that build-up inside the blood vessels. Stroke can occur if the artery narrows sufficiently or, a blood clot forms, or when plaque breaks off traveling to a smaller artery causing blockage in blood flow to the brain. Risk factors for CAD are similar to those for coronary heart disease. Family history of artherosclerosis, diabetes, smoking, hypertension, high levels of LDL, or a history of coronary heart disease, can lead to artherosclerosis. The risk is higher in men than in women less than age 75, but higher in women over the age of 75.    

Symptoms can include loss of vision, slurred speech, weakness or numbness in the extremities, and difficulty in swallowing or coordination. Carotid duplex ultrasound, angiography or computerized tomography will confirm CAD. Medication or lifestyle changes are the first choice of treatment. In high-risk cases, an intervention may be necessary to prevent a stroke. Carotid endarterectomy (CEA) carries the risk of stroke.

High-risk patients who have had a transient ischemic attack (TIA) or a completed stroke, and have more than 70 percent blockage in the carotid artery are candidates for CEA. Carotid Artery Stenting (CAS) is an alternative for patients who are at high risk for the traditional surgical procedure. CAS. It is less invasive, and typically requires a one-day hospital stay.

However, CAS is currently “investigational”. Controversies exist in spite of the data that supports the value of CAS particularly as it relates to the outcomes from the Stenting Angioplasty Protection Patients High Risk Endarterectomy (SAPPHIRE) and Acculink for Revascularization of Carotid in High Risk Patients (ARCHeR) studies that are identical to that of an endarecteromy in most patients. Experts are reviewing whether CAS offers additional clinical benefits in high-risk patients who are elderly, have medical comorbidities or other surgical challenges. Some believe that the SAPPHIRE and ARCHeR trials prove nothing other than the fact that asymptomatic high-risk patients should be treated conservatively and that the SAPPHIRE study found no significant difference in incidence of the traditional stroke trial outcomes between treatment groups. Although the ARCHeR trial did provide some objective evidence of risks associated with carotid angioplasty/stenting, some say that the registry design and other flaws limit its value in truly defining the role of CAS versus CEA.    

Until all the data from these and other randomized and registry-based clinical trials reveal the value of CAS, many experts are of the opinion that endovascular therapies should serve as an alternative, not as a gold standard.

A distinguished panel of vascular surgeons will review updated data from the SAPPHIRE, ARCHer and the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) as well as new data on the results of the CABERNET 30-day trial (a single-arm, prospective, non-randomized trial of 450 high-risk patients enrolled for CEA at 15 sites across the United States), and the BEACH Trial, (a prospective, non-randomized, single arm clinical trial that enrolled 747 patients at 47 U.S. sites, of which 480 patients were enrolled in the pivotal phase of the trial including symptomatic patients with stenosis of 50% or greater and asymptomatic patients with stenosis 80% or greater). Opinions regarding which stent and embolic device should be used for specific types of lesions, when recurrent stenosis after CAS or CEA should be treated and new techniques used for carotid angioplasty and stenting will be covered. These discussions will take place on Sunday, November 21, 6:30 a.m. – 1:00 p.m. during the VEITHsymposium™ in New York.

Now entering its fourth decade, VEITHsymposium™ has been the epicenter of physician education for the global vascular community. This international congress attracts over 1,500 thought leaders in the field. More than 250 international clinician/educators present the latest topics, advances and data and then validate these concepts through the dynamic interactive faculty/audience exchange that ends each session.

VEITHsymposium™ is sponsored by Montefiore Medical Center (Bronx, NY) with CME credit issued by Albert Einstein College of Medicine (Bronx, NY).