A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Peter Ringleb - Top 30 Publications

Body mass index and outcome after revascularization for symptomatic carotid artery stenosis.

To determine whether the obesity paradox exists in patients who undergo carotid artery stenting (CAS) or carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.

Asymptomatic Extracranial Vertebral Artery Disease in Patients with Internal Carotid Artery Stenosis.

Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood.

Influence of a combined CT/C-arm system on periprocedural workflow and procedure times in mechanical thrombectomy.

To achieve the fastest possible workflow in ischaemic stroke, we developed a CT/C-arm system, which allows imaging and endovascular treatment on the same patient table.

Sex Differences and Functional Outcome After Intravenous Thrombolysis.

Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care.

Erratum to: Thrombectomy for ischemic stroke: meta-analyses of recurrent strokes, vasospasms, and subarachnoid hemorrhages.

Sex and Stroke in Thrombolyzed Patients and Controls.

We hypothesized that any sex-related difference in outcome poststroke is explained by other prognostic factors and that the response to intravenous recombinant tissue-type plasminogen activator (r-tPA) is equal in males and females after adjustment for such factors.

Endovascular stroke therapy may be safe in patients with elevated international normalized ratio.

Endovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials.

Access, timing and frequency of very early stroke rehabilitation - insights from the Baden-Wuerttemberg stroke registry.

While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice.

Effect of Conscious Sedation vs General Anesthesia on Early Neurological Improvement Among Patients With Ischemic Stroke Undergoing Endovascular Thrombectomy: A Randomized Clinical Trial.

Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from randomized trials.

Adverse Events Following International Normalized Ratio Reversal in Intracerebral Hemorrhage.

Prothrombin complex concentrates (PCCs) are frequently used to reverse the effect of vitamin K antagonists (VKAs) in patients with non-traumatic intracerebral hemorrhage (ICH). However, information on the rate of thromboembolic events (TEs) and allergic events after PCC therapy in VKA-ICH patients is limited.

Capillary Transit Time Heterogeneity Is Associated with Modified Rankin Scale Score at Discharge in Patients with Bilateral High Grade Internal Carotid Artery Stenosis.

Perfusion weighted imaging (PWI) is inherently unreliable in patients with severe perfusion abnormalities. We compared the diagnostic accuracy of a novel index of microvascular flow-patterns, so-called capillary transit time heterogeneity (CTH) to that of the commonly used delay parameter Tmax in patients with bilateral high grade internal carotid artery stenosis (ICAS).

Thrombectomy for ischemic stroke: meta-analyses of recurrent strokes, vasospasms, and subarachnoid hemorrhages.

Mechanical thrombectomy with stent retrievers is an effective treatment for patients with ischemic stroke. Results of recent meta-analyses report that the treatment is safe. However, the endpoints recurrent stroke, vasospasms, and subarachnoid hemorrhage have not been evaluated sufficiently. Hence, we extracted data on these outcomes from the five recent thrombectomy trials (MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND IA published in 2015). Subsequently, we conducted meta-analyses for each outcome. We report the results of the fixed, as well as the random effects model. Three studies reported data on recurrent strokes. While the results did not reach statistical significance in the random effects model (despite a three times elevated risk), the fixed effects model revealed a significantly higher rate of recurrent strokes after thrombectomy. Four studies reported data on subarachnoid hemorrhage. The higher pooled rates in the intervention groups were statistically significant in both, the fixed and the random effects model. One study reported on vasospasms. We recorded 14 events in the intervention group and none in the control group. The efficacy of mechanical thrombectomy is not questioned, yet our results indicate an increased risk for recurrent strokes, subarachnoid hemorrhage, and vasospasms post-treatment. Therefore, we strongly recommend a thoroughly surveillance, concerning these adverse events in future clinical trials and routine registries.

One-pass endovascular treatment of intracranial atherosclerotic stenosis with a novel PTA balloon and self-expanding microstent.

We present a novel endovascular technique to treat intracranial atherosclerotic stenosis (ICS) with the specific potential to reduce the procedure-related complications which so far limited safety and efficacy of endovascular ICS intervention.

Restriction of therapy mainly explains lower thrombolysis rates in reduced stroke service levels.

To assess the influence of preexisting disabilities, age, and stroke service level on standardized IV thrombolysis (IVT) rates in acute ischemic stroke (AIS).

Time-dependent parameter of perfusion imaging as independent predictor of clinical outcome in symptomatic carotid artery stenosis.

Carotid artery stenosis is a frequent cause of ischemic stroke. While any degree of stenosis can cause embolic stroke, a higher degree of stenosis can also cause hemodynamic infarction. The hemodynamic effect of a stenosis can be assessed via perfusion weighted MRI (PWI). Our aim was to investigate the ability of PWI-derived parameters such as TTP (time-to-peak) and T(max) (time to the peak of the residue curve) to predict outcome in patients with unilateral acute symptomatic internal carotid artery (sICA) stenosis.

Treatment With Prothrombin Complex Concentrate to Enable Emergency Lumbar Puncture in Patients Receiving Vitamin K Antagonists.

Lumbar punctures are frequently necessary in neurologic emergencies, but effective oral anticoagulation with vitamin K antagonists represents a contraindication. We report the effectiveness of prothrombin complex concentrates to reverse vitamin K antagonist to enable emergency lumbar punctures, as well as evaluate lumbar puncture- and prothrombin complex concentrates-related complications.

Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy.

Embolization of thrombus fragments in a new vascular territory is a potential adverse event in neurothrombectomy. This study was performed to evaluate the safety and feasibility of a novel approach combining proximal balloon occlusion and distal aspiration to prevent distal thrombembolic complications.

Does Stroke Severity for Repeated Thrombolysis Matter? Response to the Letter by Wu et al.

Safety of Endovascular Thrombectomy in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulants.

Prospective data on the safety of endovascular thrombectomy in acute stroke patients on non-vitamin K antagonist oral anticoagulants are lacking.

Pioglitazone after Ischemic Stroke or Transient Ischemic Attack.

Patients with ischemic stroke or transient ischemic attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a risk factor for stroke and myocardial infarction raised the possibility that pioglitazone, which improves insulin sensitivity, might benefit patients with cerebrovascular disease.

Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials.

Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the association of age with treatment differences in symptomatic patients and provide age-specific estimates of the risk of stroke and death within narrow (5 year) age groups.

Performance of e-ASPECTS software in comparison to that of stroke physicians on assessing CT scans of acute ischemic stroke patients.

The Alberta Stroke Program Early CT score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We compared the performance of the e-ASPECTS software with those of stroke physicians at different professional levels.

Cortical vessel sign on susceptibility weighted imaging reveals clinically relevant hypoperfusion in internal carotid artery stenosis.

Internal carotid artery (ICA) stenosis can lead to cerebral hypoperfusion and is a common cause of stroke. As susceptibility weighted imaging (SWI) has been used for penumbra imaging in acute ischemic stroke, we aimed at analyzing hypoperfusion using SWI in patients with ICA stenosis.

Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke.

We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live alone without help of another person before stroke (dependent patients) versus independent ones.

European Cooperative Acute Stroke Study-4: Extending the time for thrombolysis in emergency neurological deficits ECASS-4: ExTEND.

Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is an effective and approved therapy for acute ischemic stroke within 4.5 h of onset except for USA, Canada, Croatia, and Moldovia with a current 3 h label. We hypothesized that ischemic stroke patients selected with significant penumbral mismatch on magnetic resonance imaging (MRI) at 4.5-9 h after onset of stroke will have improved clinical outcomes when given intravenous rt-PA (alteplase) compared to placebo.

Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry.

The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18-50 years. Data from a consecutive and prospective stroke registry was analyzed that covers a federal state with 10.8 million inhabitants in southwest Germany.

Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis.

We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.

Repeated Intravenous Treatment with Recombinant Tissue-Type Plasminogen Activator in Patients with Acute Ischemic Stroke.

Increased use of systemic thrombolysis, demographic changes, and higher chances of surviving first-ever strokes all lead to an increasing number of patients with recurrent stroke. However, data on repeated thrombolysis are limited. Here, we report on the safety and clinical effects of repeated intravenous recombinant tissue-type plasminogen activator (rt-PA) treatment in a large consecutive cohort of stroke patients.

Follow-up C-reactive protein level is more strongly associated with outcome in stroke patients than admission levels.

The value of C-reactive protein (CRP) as a prognostic tool in stroke patients is unclear. The aim of this study is to explore the prognostic impact of CRP levels assessed at different time points on functional outcome in a large cohort of thrombolysed acute stroke patients. All thrombolysed stroke patients admitted to our department were entered in an open, prospective database. Clinical and demographic data were recorded. CRP was measured upon admission, within 24 h, and in the following days. Functional outcome was assessed using the modified Rankin Scale (mRS) at 3 months. Among 1242 thrombolysed patients, we found a statistically significant difference in median CRP values upon admission, within 24 h, and follow-up with respect to outcome parameters (p < 0.001) including symptomatic intracerebral hemorrhage (sICH; p < 0.001). In regression models, follow-up CRP showed better predictive properties for outcome parameters compared to CRP assessed upon admission or within 24 h. The ROC analysis showed a good predictive value of follow-up CRP concerning dependent outcome [c-statistic 0.71 (95 % CI 0.67-0.75) p < 0.001] and mortality [c-statistic 0.70 (95 % CI 0.66-0.75) p < 0.001]. After adjustment for risk factors, follow-up CRP, but not admission CRP, was independently associated with dependent outcome (OR 2.67, 95 % CI 1.76-4.06; p < 0.001), mortality (OR 2.53, 95 % CI 1.50-4.25; p < 0.001), and sICH (OR 3.03, 95 % CI 1.51-6.06; p = 0.002). Follow-up CRP is strongly associated with functional outcome, sICH, and mortality after 90 days in thrombolysed stroke patients.

Sex and Hemisphere - A Neglected, Nature-Determined Relationship in Acute Ischemic Stroke.

Sex differences in the structural connectome of the brain are clinically highly relevant, but they have mostly been neglected in stroke trials. We investigated the impact of the interaction sex-by-hemisphere on outcome in stroke patients after intravenous thrombolysis (IVT).