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(Stroke. 2003;34:e44.)
© 2003 American Heart Association, Inc.

Letters to the Editor

"Mobile Stroke Unit" for Hyperacute Stroke Treatment

Klaus Fassbender, MD; Silke Walter, MD; Yang Liu, MD Frank Muehlhauser, MD

Department of Neurology, University of Goettingen, Goettingen, Germany

Andreas Ragoschke, MD; Sandra Kuehl, PhD Orell Mielke, MD

Department of Neurology, University of Heidelberg, Mannheim, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Ischemic stroke is a major cause of death and of permanent severe functional deficits in the developed countries. In most cases this disease is caused by obstruction of the cerebral blood vessels, ie, by emboli originating from the heart or large brain-supplying blood vessels. Experimental studies show that within minutes after vascular obstruction, cell death occurs in the core of the focal ischemic brain tissue. In the region around this core (penumbra), cells exhibit a compromised metabolism but might be rescued by adequate therapies.¹

At present, the only acute treatment for acute stroke that has been shown to be effective and that has been approved in most Western countries is thrombolysis of the obstructing emboli by recombinant tissue plasminogen activator (rtPA).² However, even in centers specialized for stroke <5% of the stroke patients are treated by thrombolysis. One explanation for this may be that most patients arrive at the hospital after the temporal window of 3 hours for the use of rtPA.^3–5 Even this arbitrarily set temporal window might still be too large as indicated by pathophysiological knowledge¹ and clinical observations.^6–8 Much better outcomes can be expected if treatment would start within 1 hour. Thus, the major problem of acute stroke treatment is the unacceptable delay between onset of cerebral ischemia and therapeutic restoration of the cerebral blood flow.

Since thrombolysis for ischemic stroke can only be performed after exclusion of possible hemorrhage, computed tomography (CT) is the major time-determining factor in stroke management. Usually only larger . . . [Full Text of this Article]

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