1. Demography TEMPiS Control group 1971 1151 No patients Sex 49%53% Age [Mean, years] 72,772,9 Lancet Neurol 2006; 5: 742–48

2. Quality of procedures TEMPiS Control group 4.6%0.4% * 82%10% * Systemic rtPA Carotis duplex Speech therapy 83%62% * 78%51% * Test of swallowing dysfunction 10.711.9 * 11%10% In-hospital stay [days] External transfers Lancet Neurology 2006

3. Poor Outcome after 3 Months TEMPiS Control hospitals 18,1% 16,2% Dead Institutional Care 12,5% 14,2% At home with severe disability 14,3% 21% -10,4% ** Lancet Neurology 2006

4. other vascular disease OR=1,35 Atrial fibrillation OR=1,35 Living with a partnerOR=0,69 Diabetes mellitusOR=1,50 Intracerebral hemorrhage OR=2,88 moderate deficits OR=2,28 severe deficits OR=6,23 very severe deficits OR=23,06 >85 yearsOR=6,39 76-85 years OR=2,74 65-75 yearsOR=1,63 TEMPiS OR=0,63 Odds Ratios for Poor Outcome Reference age<65 Reference mild deficits

5. Summary ► European health care systems have to prepare for a growing number of stroke cases in the next 20 years ► Telemedical networks offer a new and innovative approache to improve stroke care in underserved, non-urban areas ► Tele-Thrombolysis is safe and effective ► Network Stroke care reduces the probability of poor outcome after 3 months

6. Penumbra Concept  Driving force of acute stroke care: Time is brain! Penumbra = Tissue at riskInfract core 0 h 1 h 8 h 8-12 h Penumbra Concept of Ischemic Stroke

7. North Karelia Project Community based Intervention  Multilevel Riscfactor-Modification (Media, GPs, Industry…)  Treating and preventing all CV Risc factors