[Treatment reality of internal carotid artery stenosis in Germany : requirement and reality in international comparison and in light of the current S3 guidelines].
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.


CONCLUSIONS
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.
Neurologische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Ruhr Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland. eyding@web.de.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland. eyding@web.de.
J
J
Eyding
Neurologische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Bochum, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
M
M
Kitzrow
Neurologische Klinik, Universitätsklinikum St. Josef-Hospital, Ruhr Universität Bochum, Bochum, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
C
C
Krogias
Neurologische Klinik, Klinikum Dortmund GmbH, Dortmund, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
G
G
Reimann
Neurologische Klinik, Alfried Krupp Krankenhaus Essen, Essen, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
R
R
Weber
Neurologische Klinik, Universitätsklinikum Essen, Essen, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
C
C
Weimar
drg market Osnabrück, Osnabrück, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
D
D
Bartig
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000592:standards / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D015607:Stents / Q000592:standards / Q000706:statistics & numerical data*
Angioplasty; Asymptomatic; Carotid artery stenosis; Endarterectomy; Symptomatic