Comments on: December Blog Entries: Carotid Disease http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/ Promedica International CME Sun, 01 Aug 2010 03:31:01 +0000 http://wordpress.org/?v=2.1 By: ramon berguer http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-905 ramon berguer Mon, 15 Dec 2008 20:02:38 +0000 http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-905 Sapphire is a poster child for clever manipulation of patient sourcing and selecting/ignoring primary outcomes for the convenience of positive results. EVA-3S was prospectively randomized and showed superiority of endarterecdtomy over CAS (and the knee-jerk criticism that its results were the consequence of a greater procedural expoertise in the surgical group than in the stent group have been debunked through retrospective outcome analysis) Until CREST is concluded the best proven outcomes remain on the side of carotid endarterectomy. rb Sapphire is a poster child for clever manipulation of patient sourcing and selecting/ignoring primary outcomes for the convenience of positive results. EVA-3S was prospectively randomized and showed superiority of endarterecdtomy over CAS (and the knee-jerk criticism that its results were the consequence of a greater procedural expoertise in the surgical group than in the stent group have been debunked through retrospective outcome analysis) Until CREST is concluded the best proven outcomes remain on the side of carotid endarterectomy.

rb

]]> By: Nick Cheshire http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-906 Nick Cheshire Tue, 16 Dec 2008 05:24:35 +0000 http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-906 The SPACE trial results are amongst the most robust of all the comparative RCTs and show no clinically relevant difference in outcomes between CAS & CEA. At least part of the problem is that most surgeons who offer CEA cannot provide CAS - and vice versa; hence the antagonism and spurious need for one technique to prove superiority over the other - for all presentations. Patient selection for the most appropriate method gives best results and will probably be the future. The SPACE trial results are amongst the most robust of all the comparative RCTs and show no clinically relevant difference in outcomes between CAS & CEA.
At least part of the problem is that most surgeons who offer CEA cannot provide CAS - and vice versa; hence the antagonism and spurious need for one technique to prove superiority over the other - for all presentations. Patient selection for the most appropriate method gives best results and will probably be the future.

]]> By: Guy-André Pelouze http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-910 Guy-André Pelouze Fri, 02 Jan 2009 19:29:16 +0000 http://blog.promedicacme.com/2008/12/11/december-blog-entries-carotid-disease/#comment-910 1/ treatment of carotid atheroma in symptomatic patients is clearly beneficial only if the morbimortality rate of the procedure is low, below 3% as medical treatment had improved very substantially with the combination of 80 mg atorvastatin and antiplatelet agents. 2/ treatment of asymptomatic patients is in my mind very controversial. Only centers with very low MMR could discuss such cases and operate on these patients. I am not aware of RCT of asymptomatic patients where CAS performed a MMR 1/ treatment of carotid atheroma in symptomatic patients is clearly beneficial only if the morbimortality rate of the procedure is low, below 3% as medical treatment had improved very substantially with the combination of 80 mg atorvastatin and antiplatelet agents.
2/ treatment of asymptomatic patients is in my mind very controversial. Only centers with very low MMR could discuss such cases and operate on these patients. I am not aware of RCT of asymptomatic patients where CAS performed a MMR

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