International Stroke Conference Digest - February 21, 2008 - (Page 4)

2008 isC digest | New Orleans | February 21 4 A new perspective in the CAS vs. CEA debate i n t r e atm e n t of c a ro t i d atherosclerotic disease, there has long been a debate over which surgical treatment is better — carotid artery stenting or carotid endart erectomy. At least one expert presenter in a session this morning hopes to change the focus of the debate to which patients are better for each type of surgery. I n t he sy mposia t it led “Moder n Management of Carotid Atherosclerotic Disease,” L. Nelson Hopkins, MD, will get to the heart of the debate during his lecture “How I Decide Which Patients Get CAS, and Which Patients Get CEA: The Perspective of a Physician Who Performs Both.” The symposium begins at 9:10 a.m. in Room RO-6 on Level 2 of the convention center. “There’s been a lot of debate and controversy over the last several years over the merits of what’s better, endarterectomy or stenting and angioplasty,” said session moderator Brian Hoh, MD. “And there have been a number of trials in Europe, and there’s the CREST trial in the U.S., trying to answer this question. And here we have somebody who performs both procedures — so there must be situations or patients in which he feels one is better than the other.” Dr. Hoh sa id he hopes t hat Dr. Hopkins’ talk will change physicians’ perspectives. “Perhaps the better question to ask would be, ‘Who is the appropriate candidate for which treatment?’” Brian Hoh, MD Dr. Hopkins is a Professor and Chair at the University of Buffalo Department of Neurosurger y, and Director of the Toshiba Stroke Research Center, also at the University of Buffalo. He is also Chief of Neurosurgery for Kaleida Health in Buffalo. Also during the session, E. Sander C o n n o l l y, J r . , M D , w i l l a d d r e s s neuropsychological outcomes after carotid endarterectomy. Dr. Hoh said that many clinical trials comparing the two available surgeries take into account post-surgical statistics such as stroke rate, death rate, or myocardial infarction rate. “But what Dr. Connolly has shown over the last several years is that while surgeons may see a patient they have done a carotid endarterectomy on back in the office and think they’re doing great, a large percentage of those patients have subtle neurocognitive or neuropsychological changes after surgery that affect their every day life,” said Dr. Hoh, noting that Dr. Connolly will present serum markers that predict whether a patient will experience these cognitive changes. The third lecture in the session is “Management of Asymptomatic Carotid Stenosis” by Gary Nesbit, MD. Dr. Hoh said there is no consensus for treatment of asymptomatic patients. He also pointed out that much of the controversy stems from the fact that carotid stenting is not reimbursed for patients with asymptomatic disease. “We see patients with asymptomatic carotid stenosis everyday, so this may influence whether physicians treat those patients with medicine or with invasive treatment,” said Dr. Hoh, who is Assistant Professor of Neurological Surgery and Radiology at the University of Florida College of Medicine. He holds the William Merz Professorship in Neurological Surgery and is the Associate Residency Director. To conc lude t he session , Jef f rey Sunshine, M D, PhD, w ill discuss the newest modalities in imaging for carotid atherosclerotic disease.

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International Stroke Conference Digest - February 21, 2008

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