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W Kurre1, A Berlis2, H-C Diener3

  • 1Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Deutschland. w.kurre@klinikum-stuttgart.de.

Clinical Neuroradiology
|October 21, 2015
PubMed
Summary

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This summary is machine-generated.

Reimbursement for intracranial stenting in Germany is debated following the SAMMPRIS study. Current IQWiG reports on stent-angioplasty for intracranial stenosis, including emergency procedures, are critically reviewed.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Health Economics

Background:

  • Ongoing debate in Germany regarding reimbursement for stent-angioplasty in treating intracranial stenoses.
  • The SAMMPRIS study results favored medical management over stent-angioplasty with the Wingspan® stent system, initiating discussions.
  • The German Institute for Quality and Efficiency in Health Care (IQWiG) published a report (Rapid report N14-01) based on SAMMPRIS, influencing decision-making.

Purpose of the Study:

  • To critically evaluate the IQWiG report GA15-02 concerning stent-angioplasty for intracranial artery stenosis, including emergency treatments in Germany.
  • To outline the design and interpretation of the SAMMPRIS and VISSIT trials from a professional perspective.
  • To summarize the current status of the reimbursement discussion for intracranial stenting.

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Main Methods:

  • Review of the SAMMPRIS and VISSIT trial designs and results.
  • Analysis of the IQWiG report GA15-02, focusing on the transferability of results to emergency treatments.
  • Critique of the methodology and conclusions presented in the IQWiG report regarding emergency intracranial stenting.

Main Results:

  • The IQWiG report concluded that results from studies like SAMMPRIS are transferable to emergency treatments, a view contested by medical professionals.
  • Limitations of the SAMMPRIS trial and crucial indications for intracranial stenting (e.g., acute vessel occlusion, hemodynamic impairment) were previously highlighted.
  • The IQWiG report's analysis of emergency treatments in Germany relied on limited retrospective case series (31 patients), not reflecting current practice.

Conclusions:

  • It is scientifically unacceptable to compare outcomes of secondary prophylactic treatment with emergency procedures.
  • The current IQWiG report's assessment of emergency intracranial stenting lacks robust evidence and misinterprets trial applicability.
  • Further discussion is needed to address the specific indications and appropriate reimbursement for intracranial stenting, particularly in emergency settings.