Most Asymptomatic Patients with Carotid Stenosis are Best Treated with Best Medical Therapy
Frank J. Veith, MD, New York University
Columbia University Vascular Conference, New York, NY
Table of Contents
Most Asymptomatic patients with carotid stenosis are best treated with BMRx & CREST & ACST not change that
0:00:02
I can cover that topic in about 8 minutes so I'd like to expand my title
0:00:29
How should we interpret CREST, other recent carotid trials & AHA guidelines in SX & ASX patients with carotid stenosis
0:00:43
Alternate title - Spinning / misinterpreting of crest, other recent carotid trials & AHA/ASA/ACC/SVS etc guidelines
0:01:06
Purpose of CAS like CEA
0:01:21
History of CAS
0:01:52
My role in CAS
0:02:21
More History of CAS
0:03:10
In CAS vs CEA battle
0:03:50
Key points since the landmark trials and 1990s
0:04:31
Decreasing annual stroke rate with ASX carotid stenosis
0:04:57
Currently I believe that
0:05:46
So let us consider facts about invasive treatment for asymptomatic carotid stenosis
0:05:57
What is basis for Rx ASX CS with CEA/CAS
0:06:17
Landmark ASX Trials (ACAS, VA, ACST) showed
0:06:35
In these landmark ASX trials (ACAS, VA, ACST)
0:07:06
and these landmark trials cannot justify invasive carotid treatment today
0:08:10
Decreasing annual stroke rate with asx carotid stenosis
0:08:41
Effectiveness of BMRx in patients with ASX CS is huge
0:09:04
So with asymptomatic carotid stenosis
0:09:56
We also need to know
0:10:48
Until we have such evidence INVAS carotid treatment should largely be restricted to SX PTS
0:11:40
Medical Rx is better for most asymptomatic patients with carotid stenosis
0:12:00
Conclusion
0:12:26
BMRx is what I would choose for myself if I had an ASX Carotid stenosis
0:12:32
I am a CAS enthusiast with symtomatic patients
0:12:58
What is best Rx for symptomatic carotid stenosis now How Crest influences How crest being spun How crest influenced AHA guidelines
0:13:18
CREST Well designed well conducted exemplary RCT
0:13:32
CREST CEA vs CAS in symptomatic & asymptomatic patients
0:13:58
CREST facts
0:14:24
CREST-Data
0:14:47
But was CREST an exemplary RCT???
0:15:16
Lets look carefully at CREST - its details and data & its flaws
0:15:33
CREST - Data details
0:15:51
CREST - Flaws and Issues
0:16:43
What is value of CREST How should be use it?
0:18:26
ICSS showed CAS vs CEA in SX patients
0:19:01
What about AHA SVS etc guidelines
0:19:53
CREST, etc - my no spin conclusions in SX patients
0:20:59
CREST - my no spin conclusions in ASX patients
0:21:28
My opinions - in future
0:22:05
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Frank J. Veith, MD, discusses how we should be interpreting CREST, other recent carotid trials & AHA guidelines in SX & ASX patients with carotid stenosis.
 
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Jul 20, 2011 530 VA:06:20:6380:2011
 
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