[It is more than transportation time only: "Drip and ship" delays endovascular thrombectomy in stroke]. / Es ist nicht nur die Transportzeit ­ Das "Drip and ship"-Verfahren kostet Zeit.

BACKGROUND: Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are acute therapies approved for ischemic stroke. In Germany there are approximately 110 supra-regional stroke units with and approximately 200 regional stroke units without 24 / 7 EVT. Regional stroke units must cooperate with supra-regional stroke units in order to offer EVT if indicated. In the current paper, we discuss the time delay due to secondary transportation from regional to supra-regional stroke units. METHODS: Acute stroke therapy of all patients treated at the regional stroke unit of the SRH Clinics in Sigmaringen in 2016 was analysed retrospectively. Sigmaringen cooperates with the supra-regional stroke units of the Oberschwabenklinik Ravensburg and the University Hospital Tübingen. RESULTS: A total of 299 patients with ischemic stroke and 168 patients with transient ischemic attack (TIA) were treated at the Sigmaringen stroke unit. Of these, 52 patients received IVT and 21 patients were transferred for EVT; of these, 15 patients actually underwent EVT after their cases were reviewed. The CT-to-Groin-times were more than double as long as compared to those in patients directly admitted to the supra-regional stroke units (median 180 minutes vs. 88 minutes). DISCUSSION: Primary admission of patients with acute stroke to regional stroke units without EVT prolongs the CT-to-Groin time. Implications of this knowledge on current and future patient care structures are discussed.

Ultrasound diagnostics of the vertebrobasilar system.

Despite the fact that ischemic stroke in the vertebrobasilar system (VBS) is significantly less frequent than in the carotid system, abnormalities found in Doppler and duplex examinations are about as prevalent in the VBS as in the carotid system. Because of the potentially severe clinical deficits associated with stroke of the VBS and the increased risk for stroke under conditions, such as underlying symptomatic vertebrobasilar stenosis and general anesthesia, it is highly desirable to have reliable methods available to identify pathological changes of the VBS. Furthermore, because the VBS via the circle of Willis can play a significant role as collateral blood supply system when vessels of the anterior circulation have been compromised, the knowledge of the VBS is necessary to estimate the overall integrity of the remaining blood flow to the brain.