NVAC just tells the game to not crash, it does not fix anything, so you have to live with any side effects of game not crashing when it should have.
So it will allows you to play with a bad conflicting mod list by preventing crashing till game is unplayable or save is corrupted beyond repair.
On the other hand, it will prevent a correct set up to work flawlessly. That's why it's not recommended anymore in those guides.
That said, if you plan to make a play-through with mods that are known to cause crash and have no fix, NVAC is a must
CASM is replaced by fucntions found in Stevie's tweaks which is a must have.
https://www.nexusmods.com/newvegas/mods/66347