Stroke Angel: Effect of Telemedical Prenotification on In-Hospital Delays and Systemic Thrombolysis in Acute Stroke Patients.

Introduction: Door-to-CT scan time (DCT) and door-to-needle time (DNT) are important process measures in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT). We examined the impact of a telemedical prenotification by emergency medical service (EMS) (called the "Stroke Angel" program) on DCT and DNT and IVT rate compared to standard of care.

Patients And Methods: Two prospective observational studies including AIS patients admitted via EMS from 2011 to 2013 (cohort I; n = 496) and from January 1, 2015 to May 31, 2018 (cohort II; n = 349) were conducted.

Implant for Augmentation of Cerebral Blood Flow Trial-1 (ImpACT-1). A single-arm feasibility study evaluating the safety and potential benefit of the Ischemic Stroke System for treatment of acute ischemic stroke.

Background: The Ischemic Stroke System is a novel device designed to deliver stimulation to the sphenopalatine ganglion(SPG).The SPG sends parasympathetic innervations to the anterior cerebral circulation. In rat stroke models, SPG stimulation results in increased cerebral blood flow, reduced infarct volume, protects the blood brain barrier, and improved neurological outcome.

[Home-based telerehabilitation after stroke].

The use of modern information and telecommunication technologies enables telerehabilitation of neurological deficits in the domestic environment. The current state of studies on rehabilitative teletherapy for improvement of motor function and mobility deficits due to stroke is reviewed. Two neurolinguistic proof of concept studies investigating the efficacy of online interactive telespeech therapy are reported, which compared virtual screen to screen interactive telerehabilitation of aphasia after stroke and dysarthrophonia in Parkinson's disease to conventional face to face rehabilitation.

[Telemedical prenotification in acute stroke treatment : Experiences from the Stroke Angel initiative from 2004 until the present].

Objective: The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke.

Material And Methods: Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhön-Grabfeld and Bad Kissingen since 2005.

Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder-hand syndrome: a randomized clinical trial.

Objective: To examine whether the use of a shoulder joint functional orthosis over four weeks can mitigate the development or progression of the shoulder-hand syndrome in patients with shoulder joint subluxation after stroke.

Design: Two-armed randomized controlled trial.

Setting: Rehabilitation unit of a neurological hospital, single centre.

[Mobile computing systems in preclinical care of stroke. Results of the Stroke Angel initiative within the BMBF project PerCoMed].

Background: Telemedical networks that apply innovative mobile information technologies (IT) are an innovative approach to improve stroke care in community settings. Within the German Stroke Angel initiative and the research project PerCoMed (Pervasive Computing in Medical Care, funded by the Federal Ministry of Education and Research, http://www.percomed.

Does anatomical completeness of the circle of Willis correlate with sufficient cross-perfusion during unilateral cerebral perfusion?

Objectives: The aim of the study was to evaluate the role of anatomical completeness of the circle of Willis for sufficient brain perfusion during unilateral cerebral perfusion and the methodology of the preoperative and intraoperative functional assessments of adequate cross-perfusion.

Methods: This prospective observational study included all elective patients (99) who underwent elective open arch surgery (hemiarch in 74 and arch replacement in 25 patients, respectively) at our institution between September 2004 and September 2006. Preoperative neuro-vascular evaluation included color-coded duplexsonography of the extracranial arteries, cranial CT angiography, and transcranial sonography.

[Acute treatment of patients after a stroke. From the incident site to the stroke unit].

Strokes are the third most common cause of mortality in western countries and the main cause of long-term invalidation. Systemic intravenous thrombolysis is the current therapeutical choice in acute stroke within 3 h after clinical onset but new pharmacological developments will have the potential to expand the time window for 6 h or more. To safeguard this option and for optimal treatment of stroke patients, better preclinical structures are necessary.

[Diagnostic angiography using multi-slice spiral CT in acute obstruction of the basilar artery].

Objective: To evaluate the diagnostic efficiency of CT angiography in case of clinical signs of acute brainstem infarction for the therapeutic management of catheter-based local thrombolysis.

Material And Methods: 3 patients (2 males, 1 female) suffering from an acute onset of brainstem symptoms and being suspicious of an occluded basilar artery were included into this report. 1 patient underwent selective vertebral arteriography.

[Clinical symptoms and diagnostic imaging in moyamoya disease].

Objective: Presentation of typical imaging findings and diagnostic approaches in patients suspected of moyamoya disease.

Material And Methods: Two female patients (24 resp. 44 years old) presenting with equivocal neurological symptoms (headache, recurrent monoparesis, choreiformic ataxia, grand mal seizure) were examined by means of colour-coded ultrasound, selective catheter-based angiography (DSA), CT and MRI including MR angiography.

Volumetric assessment of plaque progression with 3-dimensional ultrasonography under statin therapy.

Background And Purpose: Lowering of serum cholesterol levels with HMG-CoA reductase inhibitors (statins) slowed the progression of atherosclerosis in the carotid arteries in several clinical trials using carotid artery intima media thickness as primary outcome measure. Whereas conventional ultrasonography is limited to thin 2-dimensional image planes, 3-dimensional (3D) ultrasonography provides quantitative measurement of the entire carotid artery plaque volume. This study aims to assess the feasibility of 3D ultrasonography to monitor plaque progression in hypercholesterolemic patients.

Continuous administration of contrast medium for transcranial colour-coded sonography.

Since the introduction of contrast media, transcranial colour-coded sonography (TCCS) has become increasingly important for examination of the intracranial vessels. However, the widely practised bolus injection of these agents leads to initial blooming artefacts and thereafter the level of contrast enhancement decreases rapidly, reducing the effective time of enhancement. It was our aim to investigate the effect of continuous administration of contrast medium at a defined infusion rate.

Three-dimensional transcranial color-coded sonography for the examination of the arteries of the circle of Willis.

Because examinations of the intracranial vessels using conventional transcranial color-coded sonography (TCCS) lack spatial orientation and reproducibility, development of a three-dimensional (3-D) imaging technique is required. Three patients with middle cerebral artery (MCA) stenosis, three with suspected intracranial aneurysm, two with vascular malformation, and one healthy volunteer were investigated by 3-D TCCS using a magnetic spatial positioning sensor mounted on the transducer for simultaneous recording of the probe coordinates to create a volumetric data set. Three-dimensional transcranial color-coded sonography enabled good visualization of intracranial aneurysms and MCA stenoses.

[Effect of hormone replacement therapy during the climacteric on cerebrovascular diseases].

In epidemiological and animal studies it could be shown that a hormone replacement therapy decreased the risk of stroke. Sonographical blood flow measurement shows a positive effects to the cerebrovascular system caused by estrogen which was not modified by gestagens. In morphometric investigations by sonographical measurements of intima-media-thickness, it could be demonstrated that a positive influence by hormone replacement therapy can be achieved for a longer time.

Three-dimensional power-mode ultrasound for quantification of the progression of carotid artery atherosclerosis.

Elucidation of the dynamic nature of plaque progression has important implications for clinicians. The present study sought to establish an in vivo method for visualizing structural changes in carotid plaques. Three-dimensional reconstruction of parallel two-dimensional gray-scale B-mode ultrasound combined with power-mode examination of 38 carotid artery plaques was performed in a prospective study of 32 patients (18 men, 14 women; mean age 67.

Carotid artery stenting in patients at surgical high risk: clinical and ultrasound findings.

Angioplasty and stenting (A/S) provide an alternative for patients with simultaneous severe cardiac and cerebrovascular disease, or with medical illnesses which carry a high perioperative risk. We conducted A/S in 20 high-risk patients (15 males, 5 females, mean age = 64.5 years, range = 49-83 years) with symptomatic (n = 16) and asymptomatic (n = 4) high-grade stenosis (>70%, NASCET criterion) of the internal carotid artery.

Hormone replacement therapy in postmenopausal women: carotid intima-media thickness and 3-D volumetric plaque quantification.

Objective: The relationship between postmenopausal hormone replacement therapy (HRT) and the risk of stroke has been investigated in a number of epidemiological studies. However, data concerning the quantitative effects of HRT on carotid atherosclerosis, as measured by noninvasive ultrasound methods, are sparse.

Methods: In the present case, we examined 55 postmenopausal women (mean age 57.

Transcranial duplex sonography of middle cerebral artery stenosis: a comparison of colour-coding techniques--frequency- or power-based Doppler and contrast enhancement.

The main limitation of transcranial colour-coded duplex sonography (TCCD) is the inadequate acoustic window, which prevents transtemporal identification of the basal cerebral arteries in up to 30% of cases, especially in the elderly. TCCD with different colour-coding techniques, including frequency-based colour-flow (CFD) or power (PD) Doppler sonography, used alone or in combination with contrast media, were used in 23 patients with middle cerebral artery (MCA) stenosis. In 10 patients a contrast medium (400 mg/ml SHU 508 A) was administered because of inadequate colour-coded visualisation with TCCD.

Transcranial power mode Doppler duplex sonography of intracranial aneurysms.

The application of different color-coding techniques in transcranial color-coded duplex sonography (TCCD) was assessed for detection and measurement of the size of intracranial aneurysms. Thirty-two consecutively examined patients with 36 angiographically verified cerebral aneurysms underwent TCCD with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), and both methods with contrast enhancement. The diameters of the aneurysms were measured in comparable planes by means of angiography and TCCD-PD with and without 400 mg/ml of the monosaccharide microparticle contrast agent Levovist.

Transcranial power-mode duplex ultrasound in two patients with moyamoya syndrome.

Moyamoya syndrome is characterized by the reticulated collateralization of the intracranial vasculature distal to an occlusion of proximal intracranial vessels. In the present study this pathology was visualized in 2 patients, aged 29 and 32 years, using transcranial color Doppler imaging (TCDI). Digital subtraction angiography in both patients revealed stenosis of the intracranial portion of the internal carotid arteries, occlusion and stenosis of several cerebral arteries, and a bilateral reticulated collateral network particularly in the region of both basal ganglia, typical of moyamoya syndrome.

Three-dimensional ultrasound angiography (power mode) for the quantification of carotid artery atherosclerosis.

Three-dimensional (3D) ultrasound angiography was performed to diagnose carotid artery atherosclerosis. Thirty-five patients (15 women, 20 men) with a history of cerebrovascular disease were examined using conventional color-coded Doppler ultrasound and 3D ultrasound angiography. Carotid stenosis was initially diagnosed using continuous-wave Doppler ultrasound.

Power Doppler--a new tool for transcranial duplex assessment of intracranial vasculature.

The present study was undertaken to assess the clinical use of power Doppler (PD) as a new tool for transcranial vessel imaging. Power Doppler displays the integrated power of the Doppler signal instead of the Doppler frequency shift used in the conventional color flow Doppler (CFD) technique. Twenty-one patients were evaluated who had intracranial malformations or arterial stenoses [4 middle cerebral artery (MCA) stenoses, 2 intracranial carotid stenoses, 7 arteriovenous malformations (AVM), 5 intracranial carotid aneurysms, 3 Moya-Moya syndromes].

Power Doppler ultrasound examination of the intracerebral and extracerebral vasculature.

Power Doppler is a new ultrasound technique based on the visualization of the Doppler power spectrum. In 22 patients with different lesions of brain-supplying vessels the results of power Doppler ultrasound were compared with those of digital subtraction angiography and conventional color Doppler ultrasound. In patients with intracranial high-degree stenoses, power Doppler was largely free of those artifacts that occur with conventional color Doppler (e.

Cerebrovascular disease assessed by color-flow and power Doppler ultrasonography. Comparison with digital subtraction angiography in internal carotid artery stenosis.

Background And Purpose: An understanding of carotid atherosclerosis is important to further our knowledge regarding the etiology of cerebral ischemia, and therefore it is necessary to accurately visualize carotid stenosis. The purpose of the present study was to compare different imaging techniques to determine their advantages and disadvantages in the diagnosis and quantification of middle- and high-grade internal carotid artery stenosis. In particular, we were interested in evaluating the effectiveness of the new ultrasound technique power Doppler.