MES are not detectable in patients with chronic MCA stenoses of different degrees. No MES were found in either symptomatic or asymptomatic stenoses, regardless of the patients' medication. These results indicate that chronic MCA stenoses do not represent a significant embolic source. The absence of MES in the prestenotic Doppler sample volume, the watershed-type infarcts during follow-up, and the absence of small-vessel disease on computed tomography suggests that hemodynamic mechanisms are responsible for recurrent cerebral ischemia.

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Key performance indicators have become a common tool in bioprocess development, as they allow an objective and independent rating and ranking of process alternatives screened. A disadvantage of all key performance indicators developed so far is their strong focus on costs, which makes them neglect the influence of the production rate on the profit of the process. But, since both production costs and production rate have an equally strong impact, both should be considered when decisions have to be made. Therefore, two new key performance indicators are introduced in this work, one for batch and one for continuous processing. They combine product yield, purity performance, variable manufacturing costs, and production rate to one objective. Thereby, misguided trade-offs between these four individual measures can be replaced by one key performance indicator. This ensures a systematic development of biochemical downstream processes.

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