Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial.

Background: To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units.

Methods: We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings.

Recurrent symptomatic high-grade intracranial stenoses: safety and efficacy of undersized stents--initial experience.

Purpose: To prospectively evaluate the safety and efficacy of undersized stents used in patients with high-grade intracranial stenosis and recurrent ischemic symptoms who are undergoing medical treatment.

Materials And Methods: In 18 patients (13 men, five women; age range, 51-82 years), 20 high-grade (>70%) intracranial stenoses were selected for stent placement. All patients had transient ischemic symptoms or minor strokes while undergoing combined antithrombotic therapy with acetylsalicylic acid plus clopidogrel or anticoagulation therapy with warfarin or heparin plus acetylsalicylic acid.