J Eyding1,2, M Kitzrow3,4, C Krogias5,4, G Reimann6,4, R Weber7,4, C Weimar8,4, D Bartig9,4. 1. Neurologische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Ruhr Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland. eyding@web.de. 2. Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland. eyding@web.de. 3. Neurologische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Bochum, Deutschland. 4. Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland. 5. Neurologische Klinik, Universitätsklinikum St. Josef-Hospital, Ruhr Universität Bochum, Bochum, Deutschland. 6. Neurologische Klinik, Klinikum Dortmund GmbH, Dortmund, Deutschland. 7. Neurologische Klinik, Alfried Krupp Krankenhaus Essen, Essen, Deutschland. 8. Neurologische Klinik, Universitätsklinikum Essen, Essen, Deutschland. 9. drg market Osnabrück, Osnabrück, Deutschland.
Abstract
BACKGROUND: Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS: Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS: In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION: Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.
BACKGROUND: Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS: Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS: In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION: Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.
Authors: Thomas G Brott; Jonathan L Halperin; Suhny Abbara; J Michael Bacharach; John D Barr; Ruth L Bush; Christopher U Cates; Mark A Creager; Susan B Fowler; Gary Friday; Vicki S Hertzberg; E Bruce McIff; Wesley S Moore; Peter D Panagos; Thomas S Riles; Robert H Rosenwasser; Allen J Taylor Journal: Circulation Date: 2011-01-31 Impact factor: 29.690
Authors: J David Spence; Victoria Coates; Hector Li; Arturo Tamayo; Claudio Muñoz; Daniel G Hackam; Maria DiCicco; Janine DesRoches; Chrysi Bogiatzi; Jonathan Klein; Joaquim Madrenas; Robert A Hegele Journal: Arch Neurol Date: 2009-12-14
Authors: Anne G den Hartog; Sefanja Achterberg; Frans L Moll; L Jaap Kappelle; Frank L J Visseren; Yolanda van der Graaf; Ale Algra; Gert Jan de Borst Journal: Stroke Date: 2013-02-12 Impact factor: 7.914