Marcio Brito reports from the 32nd Charing Cross International Symposium, held at Imperial College, London from 10-13 April

The 32nd Charing Cross International Symposium (CX32) broke previous attendance records and saw messages from important trials being delivered to an international vascular and endovascular audience. The symposium was attended by 2,746 participants from 74 countries. Of these, 1,868 were physicians.

The presentation of the results of the CREST trial for the first time to a vascular audience dominated the carotid session on the first day. The results showed no statistical differences between carotid endarterectomy and stenting, and were presented by Wesley Moore, USA, vascular surgeon and co-principal investigator, as a ‘game modifier’ rather than a ‘game changer’ for carotid stenting. However, in a later carotid session taking place on Monday, William Gray, an interventional cardiologist from New York, USA, took a very different view on the CREST results, arguing that they now put carotid stenting firmly back in the game.

Key new messages from the long-term follow-up of the landmark EVAR 1 and 2 trials were delivered by Roger Greenhalgh, principal investigator, and Louise Brown, trials manager, on 11 April at CX 32. Two papers were published online by the New England Journal of Medicine on EVAR 1 and EVAR 2 immediately after the presentations. EVAR 1 showed that at 10 years, compared with open repair, endovascular repair has a lower operative mortality, but at six years the advantage of abdominal aortic aneurysm-related mortality is lost. Greenhalgh told delegates that patient preference will play a big role in such situations. For patients physically too frail for open repair, EVAR 2 showed that endovascular repair is better than no intervention in terms of aneurysm-related mortality. The voting results showed that EVAR 2 will undoubtedly change clinical practice; 92% of the audience said they will recommend EVAR in patients unfit for open repair.

On 12 May, the next generation of TEVAR devices was put to the test and the CX audience was invited to vote on their preferred device by thoracic pathology. The discussion focused on the disconnect between physicians who want different devices for the different thoracic pathologies and the industry drive for a ‘one size fits all’ solution.

On the final day of CX32, there was excitement and discussion at the renal session. The recent randomised trials which found that renal artery stenting showed no benefit over medical therapy, STAR and ASTRAL, came in for considerable criticism from some speakers. The session was chaired by Jon Moss, principal investigator of ASTRAL. Delegates were told that unless the CORAL trial results, awaited in early 2011, unveil data clearly showing the benefit of intervention, the future of renal artery stenting is very much in doubt, even though most clinicians believe a subgroup of patients do benefit from revascularisation.

This year, CX Symposium attendees also saw the start of some new courses. LINC @ CX focused on live cases transmitted from Leipzig, Germany; the CX St George’s Vascular Access Course and the CX Advanced Vascular Access Course had oral presentations and hands-on training on vascular access; and the CX Complex Case Review discussed difficult interventional cases. The popular CX Office Based Veins Course was a sell-out again with 200 people being trained on 31 stations.

Read the CX Daily News coverage on www.CXDailyNews.com. CX 33 will take place from 9 to 12 April 2011 at Imperial College, London, UK.

Marcio Brito, Editor, Vascular News

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