Stroke Unit UKE Neurology, Hamburg, DE

by Prof. Dr. Anita Arsovska, ESO member

I have met Prof. Dr. med. Christian Gerloff, FEAN, FESO during my study visit at the Stroke Unit, Clinic of Neurology at UKE Hamburg, Germany. Prof. Gerloff is Head of the Clinic and Polyclinic of Neurology and an active Fellow of the European Stroke Organization. He leads the team of highly trained professionals, continuously devoted to management of neurological diseases, including acute stroke diagnosis and treatment. The Stroke Unit provides the best possible clinical care for all phases of the stroke pathway. All suspected stroke cases have rapid assessment to diagnostic methods (CT, CT perfusion/diffusion, angiography, MRI) and treatment (i.v. thrombolysis, thrombectomy, stenting etc). The team works very closely with neuro-intensivists, interventional neuroradiologists, vascular surgeons and neurosurgeons. Academic interests and challenges are constantly discussed during the meetings in order to optimize the acute stroke management.

1.Tell us about the organizational structure of the Stroke Unit (SU) in UKE Neurology?

Our SU is managed by a team of 11 stroke physicians – neurological residents and board-certified neurologists – and 30 stroke nurses. We have 20 beds on SU, 15  of them with full monitoring, the others serve as early rehabilitation places in order to minimize interfaces between different teams, thereby allowing more direct discharges from SU into home environment or later rehabilitation phases. Besides the SU, the neurology department has 56 beds for inpatients and 12 beds on ICU. Head of SU is always an academic stroke neurologist, a senior attending, with high competence in stroke research. The stroke team undergoes continuous training including special stroke nursing qualifications but also regular dummy runs where we measure the timing from patient announcement through ER admission up until start of thrombolysis or recanalization therapy – all this in tight collaboration with our neuroradiologists. We follow a rigorous quality control system etc. UKE Neurology is leading a large-scale interdisciplinary neurovascular network here in Hamburg in order to provide services, including telestroke and drip-and-ship concepts for smaller stroke units and other hospitals in the region.

2.What is the common therapeutic approach to an acute stroke patient done by your team?

The key is a fully specialized, well trained stroke team that welcomes each stroke patient and accompanies him/her throughout all diagnostic procedures and treatments, 100% hand-in-hand with our colleagues from neuroradiology and neurosurgery. We provide 24/7 multimodal CT, stroke MRI, angiography, and thrombectomy as well as all neurosurgical procedures. We also attempt to provide maximal care to patients with TIA – in our philosophy, these patients have a lot to loose so we do not want to ‚under-treat‘ them. In addition, all patients are screened for eligibility to participate in study protocols.

Stroke Unit UKE Neurology, Hamburg, DE

3.Which studies are currently going on (focused on stroke) in UKE Neurology?

Numerous basic and clinical trials, e.g. WAKE-UP, NETS, IMPROVE, ACST-2, ACTION-2, PRECIOUS, RESPECT-ESUS, MonDAFIS, CRC936 stroke cohort and registries like the German Stroke Registry (GSR), PRODAST, RASUNOA-PRIME, EPOS. Of course, we are particularly proud of having large-scale investigator-initiated trials with public (EU or national) funding like WAKE-UP, NETS, PRECIOUS or the CRC936 stroke cohort. In the latter we study neuronal network interactions after stroke by multimodal neurophyisology and imaging techniques as well as with computational modelling approaches.

4.How do you see the present position of stroke management  in Europe and in the world, and what about future developments?

That’s a very broad question and I am sure there are other experts who are more entitled to give a good answer to this. What I can say is that Germany and large parts of Europe are in a fantastic position to deliver and further develop excellence in stroke care. We have decent ressources, a high education level throughout the population, and modern technology and infrastructure. The ESO is a great organization to put ends together and promote positive developments. However, we do have problems with digitalization in medicine, and in my opinion this is a very important aspect also in regard to any attempt to improve stroke care. A good thing to mention is that European funding sources allow us to investigate also novel therapeutic approaches beyond mere recanalization of occluded vessels, like immunomodulation which could at last help to minimize the postischemic damage and thereby extend our spectrum of therapeutic tools. Nevertheless, stroke is somewhat between ‚brain‘ and ‚cardiovascular‘ diseases in the mind of many funding organizations – also in Germany. This makes it sometimes hard to get money specifically allocated to stroke research. We need to improve awareness at the political level.

5.What activities are you planning in the field of stroke prevention / early recognition of cerebrovascular disease?

We recently started the Hamburg City Health Study (HCHS) in which we will investigate 45000 citizens of Hamburg. The participants are healthy but have at least a moderate vascular risk profile. The HCHS is an interdisciplinary effort of many UKE institutes with a primary focus on heart and brain, methodologically with a focus on combining modern imaging techniques and blood biomarkers. The participants will be followed for 6, then perspectively for 12 years in order to find better predictors and scores for stroke, vascular dementia, myocardial infarction and heart failure. I am very excited about this team effort and I am sure that we will learn a lot about cerebrovascular diseases.

Stroke Unit UKE Neurology, Hamburg, DE