CX 2022: Acute stroke programme seeks to evaluate study data and decision-making in carotid disease

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Barbara Rantner

Barbara Rantner (Munich, Germany) previews the Acute Stroke Challenges programme at CX 2022—a two-hour session featuring several debates and audience polls on carotid disease treatments—and outlines what these discussions hope to achieve.

It is a pleasure for us that the Acute Stroke Challenges session takes place on the first day of the 2022 Charing Cross symposium (CX; 26–28 April, London, UK and virtual)—where we hope to see a big audience assemble to discuss hot topics in carotid disease. With this year’s programme, we have tried to cover technical controversies as well as clinical decision-making across six debates involving experts from all over the world.

Transcarotid artery revascularisation (TCAR) serves as a new technique in the treatment of internal carotid artery (ICA) stenosis. But, though results from registries are promising, TCAR still needs to prove its efficacy and safety compared to carotid artery stenting (CAS) and carotid endarterectomy (CEA).

Decision-making for invasive treatment in patients with clinically asymptomatic ICA stenosis still remains a matter of debate. There is convincing evidence that the best medical therapy nowadays significantly reduces stroke rates in the natural course. Procedural complication rates are therefore increasingly questioned, and it might be necessary to reduce the expected periprocedural stroke rate thus far from 3% to 2%.

With the Acute Stroke Challenges session, we want
to highlight
the dynamic development in the treatment of patients with carotid stenosis.

In addition to that, best medical therapy obviously also influences the outcome of patients with symptomatic ICA stenosis. As such, the need for CEA in symptomatic patients with moderate ICA stenosis is set to be critically discussed in a debate during the Acute Stroke Challenges session.

Though it is a rare entity overall, dissecting aneurysms of the carotid artery carry a relevant stroke risk by cerebral embolisation. Treatment options for dissecting aneurysms include antiaggregation, or endovascular or open surgical repair. Which of these treatment option provides the best results is also going to be discussed in one of our debates.

Medical management of patients with ICA stenosis is crucial and, in many cases, indication for anticoagulation and/or antiaggregation is seen. Patients with ICA stenosis and concomitant atrial fibrillation pose a challenge, especially when they present with signs of transient ischaemic attack (TIA) or ischaemic stroke. We will therefore follow the question of whether these patients really need to undergo carotid revascularisation or if they are sufficiently treated via anticoagulation alone.

With the Acute Stroke Challenges session, we want to highlight the dynamic development in the treatment of patients with carotid stenosis. Stroke prevention is the primary goal and decision-making, as well as techniques, need to be chosen accordingly. Results from the ACST-2 study provided relevant new insights in the comparison of CEA and CAS. These results, amongst many others, will be presented and critically discussed at CX 2022.

 

Barbara Rantner is a vascular surgeon and the deputy chief of the Department of Vascular and Endovascular Surgery at the Ludwig Maximilian University of Munich in Munich, Germany. Her research interests include vascular epidemiology focusing on peripheral arterial disease and the treatment of patients with carotid artery stenosis. She is also co-chair of the European Society of Vascular Surgery guidelines on carotid disease. Rantner has been a member of the CX executive board since 2018, and will co-moderate this year’s Acute Stroke Challenges session.


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