Zur „S3-Leitlinie Carotisstenose“

Auswirkungen auf die Praxis
Evidenzbasierte Medizin
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Zusammenfassung

Die „S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose“ wurde im August 2012 veröffentlicht. Sie berücksichtigt die Ergebnisse der letzten prospektiv randomisierten Studien zum Vergleich von operativer („carotid endarterectomy“, CEA) und interventioneller Therapie („carotid artery stenting“, CAS). Die bisher vorliegende Langversion richtet sich hauptsächlich an Experten auf diesem Gebiet. Verkürzte Fassungen für Anwender und Patienten werden folgen. Entsprechend der Evidenzlage ist weiterhin die CEA mit Patch-Verschluss zu bevorzugen. Das Carotid artery stenting bleibt Sondersituationen vorbehalten, allerdings beinhalten die Empfehlungen einen weiten Auslegungsbereich. Ob die Leitlinien wesentlichen Einfluss auf die Versorgungspraxis nehmen werden, wird anhand der Leistungszahlen zu beobachten sein. Es ist geplant, aus den Leitlinien geeignete Qualitätsindikatoren zur Beurteilung der Therapieergebnisse zu entwickeln. Eine verpflichtende Qualitätssicherung, wie sie für die Operation seit einigen Jahren existiert, ist für CAS überfällig. Eine Leitlinie auf höchstem S3-Niveau muss kontinuierlich fortgeschrieben werden. Die Leitlinie wird sich den Ergebnissen laufender Studien zeitnah anpassen müssen.

Schlüsselwörter

Endarteriektomie Stenting Therapieergebnisse Leitlinien Prospektive randomisierte Studie 

On the S3 guidelines on carotid artery stenosis

Practical consequences

Abstract

The German guidelines on extracranial carotid stenosis - diagnostics, therapy and surveillance” were released in August 2012. The guidelines take into account the most recently published randomized controlled trials (RCTs) of carotid stenting (CAS) and carotid endarterectomy (CEA) and are therefore the current recommendation for clinical practice in Germany. A long version of the guidelines was first published and short versions for patients and physicians will follow shortly. It is generally recommended that CEA in accordance with the well-known body of evidence remains the treatment of choice and CAS is recommended for exceptional situations. In this respect the German guidelines do not differ so much from those of other countries. Currently some 30,000 CEA and 8,000 CAS procedures are performed each year in Germany. Future data collection on the basis of quality assurance (for CEA established for several years and scheduled for CAS) will show the extent to which the guidelines affect the daily clinical practice. Currently running RCTs, particularly SPACE-2 and ACST-2 will have a significant influence on the conduct of the healthcare professionals so that the guidelines will be constantly adjusted to new study results.

Keywords

Endarterectomy Stenting Treatment outcome Guidelines Randomized controlled trials 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.-DortmundDeutschland

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