Impact of hospital admission during nonworking hours on patient outcomes after thrombolysis for stroke.

Background And Purpose: Whether the time of hospital admission is relevant for short-term outcome after stroke is under debate and may depend on care facilities.

Methods: We retrospectively analyzed medical records from patients who received thrombolytic therapy within 4.5 hours of stroke onset in a stroke unit of the Charité-University Hospital Berlin (Charité; n=291) or within the stroke telemedicine (TEMPiS) network, comprising 12 community hospitals with telestroke units in Bavaria (n=616).

Depressive symptoms and quality of life after thrombolysis in stroke: the TEMPiS study.

Intravenous thrombolysis leads to a reduction of post-stroke disability. No data exist about whether depression and poor quality of life (QoL) remain relevant problems in patients with good functional outcome. We assessed mood and QoL at 3 and 6 months after stroke in consecutive patients who received intravenous thrombolysis in stroke centers and telemedicine hospitals within the TEMPiS network.

Telemedically provided stroke expertise beyond normal working hours. The Telemedical Project for Integrative Stroke Care.

Background: State-of-the-art stroke management requires neurological expertise for the recognition of complex cerebrovascular syndromes or stroke-mimicking symptoms and initiation of proven acute therapies. Many community hospitals struggle to fulfill these premises particularly at evening/nighttimes or weekends. Telemedicine can improve that situation by offering rapid access to neurological expertise, but it has not been shown to what extent it is used beyond working times.

Admission facility is associated with outcome of basilar artery occlusion.

Background And Purpose: Basilar artery occlusion (BAO) is a stroke subtype with poor prognosis, but recanalizing therapies have been reported to be effective. We investigated whether initial admission to telemedically linked general hospitals with subsequent stroke-center transfer is related to poorer outcome than direct admission to stroke centers.

Methods: All BAO cases of 3 stroke centers in Munich and 1 center in Regensburg between March 1, 2003 and December 31, 2004 were included, either if patients were directly admitted to stroke centers (n=23) or had initial admission to general hospitals of the telemedical network for integrative stroke care (TEMPiS) and secondary transfer to stroke centers (n=16).

Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany.

Background And Purpose: Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Telemedicine may help to extend its use. However, concerns remain whether management and safety of tissue plasminogen activator (tPA) administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke centers.

Fischer-344 rats are unsuitable for the MCAO filament model due to their cerebrovascular anatomy.

Middle cerebral artery occlusion (MCAO) in Fischer-344 rats results in a small variance of infarct size. However, complications are frequent especially in aged Fisher-344 rats undergoing endovascular suture occlusion of the middle cerebral artery. Analyzing our experiences with 165 Wistar, 13 Sprague-Dawley and 10 F-344 rats, we compared the incidence of impossible thread advancement and subarachnoid hemorrhage, respectively.

Application of clinical scanners in rats: experimental carotid imaging using magnetic resonance imaging, spiral computed tomography, and color duplex ultrasound.

Background And Purpose: Noninvasive small animal imaging allows for reduction of the required numbers of animals in research by providing the possibility of long-term follow-up at various time points. Additionally, correlation to the investigated respective human disease is possible as equivalent equipment is employed. The authors therefore evaluate feasibility and potential of color duplex sonography, computed tomography angiography (CTA), and magnetic resonance angiography (MRA) by the use of clinical scanners for carotid artery imaging in rats.

Closing microvascular lesions with fibrin sealant-attached muscle pads.

Fibrin sealants are used in a variety of surgical procedures, mainly for purposes of hemostasis and assisted wound healing. The combined use of fibrin sealant and autologous muscle pads for hemostasis was not reported previously. Arterial incisions in the common carotid artery in rats were closed by the combined application of fibrin sealant and an autologous muscle pad.

Thrombolysis for stroke in the elderly.

Introduction: Systemic thrombolysis with intravenous recombinant tissue plasminogen activator (rt PA) for acute ischemic stroke had been licensed for patients up to 75 years in age in many European countries and was recently extended to 80 years. This age restriction results from the potential higher risk of cerebral bleeding in the elderly. The major rt PA trials included only 42 patients above 80 years showing a potential benefit from treatment.

The role of ECA transection in the development of masticatory lesions in the MCAO filament model.

In the intraluminal suture model of middle cerebral artery occlusion (MCAO) in the rat, lesions of the masticator muscles associated with impaired functional outcome occur. We evaluated the role of external carotid artery (ECA) transection. We assessed whether isolated interruption of an arterial or a venous connection to the ECA territory was sufficient to induce masticatory hypoperfusion and lesions.

Ketamine/xylazine anesthesia for radiologic imaging of neurologically impaired rats: dose response, respiratory depression, and management of complications.

In vivo imaging of rats represents an important tool for outcome evaluation in research on stroke, brain trauma, and other neurologic diseases. Since sedation of animals is necessary to avoid artifacts, a mixture of ketamine and xylazine is frequently used for anesthesia. We assessed the suitable dosage of narcotics and its correlation to severe respiratory adverse events in 269 cases of ketamine/xylazine anesthesia in male Wistar rats for performance of magnetic resonance imaging after middle cerebral artery occlusion (MCAO) or sham surgery.

Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.

Background And Purpose: Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support.

Methods: The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria.