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DO STUDY RESULTS TRANSLATE INTO PRACTICE? INTRACRANIAL STENTING IN GERMANY

Published online by Cambridge University Press:  29 August 2017

Gerhard Schillinger ,
Ernst-Günther Hagenmeyer ,
Andreas Pritzkau  and
Jörg Friedrich
Gerhard Schillinger
Affiliation:
Medical Department, Federal Association of the Local Health Care Fundsgerhard.schillinger@bv.aok.de
Ernst-Günther Hagenmeyer
Affiliation:
Medical Department, National Association of the Statutory Health Insurance Funds
Andreas Pritzkau
Affiliation:
Research Department Hospitals, Institute of the Local Health Care Funds
Jörg Friedrich
Affiliation:
Research Department Hospitals, Research Institute of the Local Health Care Funds
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Abstract

Objectives: Enrolment into the SAMMPRIS trial published in September 2011 had to be stopped due to a 2.5 higher 30-day stroke and death rate in patients with percutaneous transluminal angioplasty and stenting (PTAS) compared with the control group with only medical therapy. After these results were published, one would have expected a change toward a clearer definition of indications for intracranial stent implantation in patients with intracranial artery stenosis, using this treatment only in patients suffering from recurrent strokes despite aggressive medical management.

Methods: The frequency of intracranial stenting and indication parameters in patients with intracranial artery stenosis were assessed from 2010 to 2013 using claims data for all inpatient episodes from Germany's largest provider of statutory health insurance.

Results: The number of intracranial stenting procedures decreased slowly from 580 in 2010 to 375 in 2013. With a rate of 29 percent there was no change between 2010 and 2013 of patients who were admitted to hospital for stent implantation, without documentation of an acute stroke or transient ischemic attack (TIA). Before PTAS, one-third of patients were admitted twice because of a stroke or TIA over a period of 5 years, 17 percent of patients had been prescribed platelet aggregation inhibitors and at least two admissions to hospital were for an ischemic cerebrovascular event before PTAS.

Conclusions: Our analysis of German claims data provides little evidence of changed indications for stenting in cases of intracranial atherosclerotic disease which one might expect to be caused by the emergence of high-level evidence.

Keywords

Intracranial stentingPercutaneous transluminal angioplasty and stentingMedical devices
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 2 , 2017 , pp. 222 - 226
Copyright
Copyright © Cambridge University Press 2017 

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