- Emergency assessment of stroke patients outside the hospital using mobile telemedical communication

Every minute counts when it comes to the treatment of acute ischemic stroke! The time from the onset of symptoms to the initial medical assessment, which today takes place in the emergency ward, should be as short as possible. No time should be lost before the imaging examination using computer tomography, so that treatment decisions can be made immediately with regard to measures for drug or catheter-assisted reopening of cerebral arteries.

During the feasibility phase of the Telestroke project, we were able to show that a telemedical assessment of the stroke patient by the duty physician at the Stroke Center is reliably possible. This opens up the possibility of gaining valuable time until diagnosis and therapy initiation through the clinical application of this telestroke pathway. This will be scientifically investigated in the following main part of the project. In this way, with the help of innovative telemedical technology, the first contact between the treatment team at the stroke center and the affected person should take place at the place where the symptoms occur.

This project is being carried out in collaboration with the Emergency Center, Medical Intensive Care Medicine, Anaesthesia, the Basel City Ambulance Service, ICT Service and Support and HighDim GmbH. (Research group leader: Prof. Ph. Lyrer).

The evidence for the effect of various acute measures, such as medication, which could have a potential benefit in stroke is evaluated. Methods: Randomized controlled multicentre clinical trials. Expected results: Documentation on the efficacy of applied drugs in acute stroke therapy (Sponsors: Various; Investigator: Prof. Dr. Ph.Lyrer, Deputy: Prof. Dr. St.Engelter). The already established treatment with systemically or intra-arterially applied thrombolytics or thrombectomies is continuously evaluated.

Characterization of molecular changes in white matter in an animal model with subcortical arteriosclerosis: The molecular mechanisms involved in subcortical arteriosclerosis are still poorly understood. Research into these mechanisms is crucial in order to be able to treat the cause of vascular leukoencephalopathy and dementia in the future. In the current study, genetic changes that lead to subcortical arteriosclerosis are being investigated in an animal model with hypertensive mice. These genetic alterations are possibly influenced by the presence of arterial hypertension. Findings from this and similar studies will contribute to the future development of neuroprotective therapies that could positively influence the risk of vascular and, in particular, leukoencephalopathy vascular dementia

(Research group leaders: Prof. Dr. Ph. Lyrer, M.-F. Ritz, PhD).

Small vessel disease of the brain is studied multidimensionally by the Stroke Research Group (imaging, neuropsychology, pathology, biomarker, etc.) (headed by PD Nils Peters) in cooperation with partners in Switzerland and abroad. Clinical neuropsychological evaluations are carried out in close cooperation with the "Stroke and Cognition Clinic" (Prof. S. Engelter) at the Felix Platter Hospital.

The primary focus here is on arteriosclerosis of the carotid artery (so-called carotid stenosis). This research focus includes the reduction of the risk of stroke through surgery (so-called endarterectomy) and vessel-opening interventions using stents, the optimization of drug therapy for shielding during these interventions, as well as research into the value of biomarkers and the image morphological representation of arteriosclerosis in personalized therapy decisions. The research methods include the implementation of large randomized therapy studies as well as the embedding of modern imaging techniques and biomarker analyses in such studies in the sense of translational research.

(Research group leader: PD Dr. Leo Bonati).

One of the focal points of stroke research - as well as patient care - concerns patients with dissections of arteries supplying the brain. The focus here is on research into pathophysiology (genetics, environmental factors), diagnostics, trigger and risk factors, as well as therapeutic options. Dissection research takes place in a national and international network CADISP (Cervical Artery Dissection and Ischemic Stroke Patients), a cooperation between various European centers to record genetic, pathophysiological and therapeutic aspects (research group leader: Prof. Dr. Engelter)

The Stroke Center Basel is also the coordinating and leading center of the multicenter therapy project (TREAT-CAD).

Clinical research on "New Oral Anticoagulants in Ischemic Stroke Patients" (NOACISP) takes place both monocentrically and multicentrically. The local Stroke Center took the lead in a multicenter analysis on the safety of thrombolysis in stroke despite the use of new oral anticoagulants. (Dr. Seiffge, Prof. S. Engelter); further work is in progress.

Studies on "First ever ischemic stroke", distribution of severity and frequency of thrombolysis (Institute of Social and Preventive Medicine, University Hospital Zurich). Coordination of the nationwide stroke registry (Swiss Stroke Registry; PD Dr. Leo Bonati).

The focus is on carrying out and regularly updating standardized meta-analyses that are published in the Cochrane Library. Specifically, the following questions are answered: therapy for internal carotid artery dissection, treatment with platelet aggregation inhibitors after carotid thrombendarterectomy and extra/arterial bypass surgery. Thrombolysis: Evaluation of various aspects of thrombolytic stroke treatment: Thrombolysis in the aged stroke patient, complications, prognosis, frequency of use, etc. Methodology: Cochrane methodology for meta-analysis of randomized controlled trials. Expected results: Objective recommendations for the treatment of different clinical stroke pathologies where treatment could not be evaluated by individual studies, but only emerged by comparing different studies.

Various drug prevention studies investigating the effectiveness of anticoagulants in preventing cerebral strokes, among other things.