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Therapie asymptomatischer Karotisstenosen

Notwendige Klärung der Evidenz mit neuem SPACE-2-Design

Treatment of asymptomatic carotid artery stenosis

Improvement of evidence with new SPACE-2 design necessary

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An Erratum to this article was published on 23 May 2014

An Erratum to this article was published on 06 April 2014

Zusammenfassung

Eine eindeutige und evidenzbasierte Therapieempfehlung für Patienten mit asymptomatischer Karotisstenose ist derzeit nicht möglich. Studien, die unter definierten Bedingungen einen Vorteil der Karotisthrombendarteriektomie gegenüber einer rein konservativen Behandlung belegen, entsprechen aus pharmakologischer Sicht nicht mehr dem heutigen Standard. Andererseits weisen Untersuchungen auf eine Schlaganfallrisikoreduktion unter konsequenter Pharmakotherapie gemäß heutigem Standard hin. Untersuchungen zum Karotisstenting als dritte Behandlungsalternative sind vor allem im Vergleich gegenüber rein medikamentöser Therapie unzureichend. Die 2009 initiierte, randomisierte, kontrollierte, multizentrischen SPACE-2-Studie soll die Frage nach der bestmöglichen Therapie asymptomatischer Karotisstenosen beantworten. Zur Steigerung der Rekrutierungszahlen als Voraussetzung für einen erfolgreichen Abschluss dieser wichtigen Studie erfolgte 2013 eine Modifizierung des Studiendesigns.

Abstract

Asymptomatic carotid artery stenosis may be treated with carotid endarterectomy (CEA), carotid artery stenting (CAS) or with best medical treatment (BMT) only. Definitive and evidence-based treatment recommendations for one of these options are currently not possible. Studies showing an advantage of CEA over BMT alone do not meet current standards from a pharmacological point of view. On the other hand, more recent data point to a further stroke risk reduction using BMT according to current standards. Studies on carotid artery stenting as a third alternative treatment are partially insufficient, especially when comparing CAS with BMT. Initiated in 2009, the randomized, controlled, multicenter SPACE-2 trial is intended to answer the question about the best treatment option of asymptomatic carotid artery stenosis; however, to increase recruitment rates as a condition for the successful completion of this important study, the trial design had to be modified.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Reiff, H. Amiri, P.A. Ringleb, O. Jansen, W. Hacke und H.H. Eckstein geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Dieser Beitrag wurde erstpubliziert in Gefässchirurgie (2013) 18:

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Reiff, T. Therapie asymptomatischer Karotisstenosen. Nervenarzt 84, 1504–1507 (2013). https://doi.org/10.1007/s00115-013-3906-5

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