Neuroprotective Effect of Remote Ischemic Conditioning in Ischemic Stroke Treated With Mechanical Thrombectomy

2019 ◽  
Author(s):  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Neuroprotective Effect ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning

Remote ischemic conditioning for acute moderate ischemic stroke (RICAMIS): Rationale and design

2019 ◽  
Vol 15 (4) ◽  
pp. 454-460
Author(s):  
Xiao-Qiu Li ◽  
Lin Tao ◽  
Zhong-He Zhou ◽  
Yu Cui ◽  
Hui-Sheng Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Studies ◽  
Ischemia Reperfusion Injury ◽  
Neuroprotective Effect ◽  
Ischemia Reperfusion ◽  
Control Group ◽  
Open Label ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Experimental Group

Rationale A large number of basic and clinical studies have proved that remote ischemic conditioning has neuroprotective effect. For example, remote ischemic conditioning showed a neuroprotective role in cerebral ischemia-reperfusion injury model. Recent clinical studies suggested that remote ischemic conditioning may improve neurological function and reduce the risk of recurrence in ischemic stroke patients. However, there is a lack of convincing evidence for the neuroprotective effect of remote ischemic conditioning on ischemic stroke, which deserves further study. Aim To explore the efficacy and safety of remote ischemic conditioning for acute moderate ischemic stroke. Sample size estimates A maximum of 1800 subjects are required to test the superiority hypothesis with 80% power according to a one-sided 0.025 level of significance, stratified by gender, age, time from onset to treatment, National Institutes of Health Stroke Scale (6–10 vs. 11–16), degree of responsible vessel stenosis, location of stenosis, and stroke etiology. Methods and design Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke is a prospective, random, open label, blinded endpoint and multi-center study. The subjects are divided into experimental group and control group randomly. The experimental group was treated with remote ischemic conditioning twice daily with 200 mmHg pressure for 10–14 days besides guideline-based therapy. The control group was treated according to the guidelines. Study outcome The primary efficacy endpoint is favorable functional outcome, defined as modified Rankin Scale 0–1 at 90 days post-randomization.

scholarly journals Remote Ischemic Conditioning for Preventing and Treating Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
Author(s):  
Wenbo Zhao ◽  
Jing Zhang ◽  
Mordechai Sadowsky ◽  
Ran Meng ◽  
Yuchuan Ding ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning

scholarly journals Effects of Remote Ischemic Conditioning on Cerebral Hemodynamics in Ischemic Stroke

2020 ◽  
Vol Volume 16 ◽  
pp. 283-299
Author(s):  
Chen Qin ◽  
Xiuli Yan ◽  
Hang Jin ◽  
Ruyi Zhang ◽  
Yaode He ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Hemodynamics ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning

scholarly journals Remote Ischemic Conditioning as an Additional Treatment for Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1934-1939 ◽  
Author(s):  
Thijs R.J. Landman ◽  
Yvonne Schoon ◽  
Michiel C. Warlé ◽  
Frank-Erik de Leeuw ◽  
Dick H.J. Thijssen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Additional Treatment ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning

Remote ischemic conditioning for acute ischemic stroke: dawn in the darkness

2016 ◽  
Vol 27 (5) ◽  
pp. 501-510 ◽  
Author(s):  
Jingrui Pan ◽  
Xiangpen Li ◽  
Ying Peng
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ischemic Preconditioning ◽  
Research Progress ◽  
High Morbidity ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Remote Ischemic Perconditioning ◽  
Neuroprotective Strategy ◽  
The Brain

AbstractStroke is a leading cause of disability with high morbidity and mortality worldwide. Of all strokes, 87% are ischemic. The only approved treatments for acute ischemic stroke are intravenous thrombolysis with alteplase within 4.5 h and thrombectomy within 8 h after symptom onset, which can be applied to just a few patients. During the past decades, ischemic preconditioning has been widely studied to confirm its neuroprotection against subsequent ischemia/reperfusion injury in the brain, including preconditioning in situ or in a remote organ (such as a limb) before onset of brain ischemia, the latter of which is termed as remote ischemic preconditioning. Because acute stroke is unpredicted, ischemic preconditioning is actually not suitable for clinical application. So remote ischemic conditioning performed during or after the ischemic duration of the brain was then designed to study its neuroprotection alone or in combination with alteplase in animals and patients, which is named as remote ischemic perconditioning or remote ischemic postconditioning. As expected, animal experiments and clinical trials both showed exciting results, indicating that an evolution in the treatment for acute ischemic stroke may not be far away. However, some problems or disputes still exist. This review summarizes the research progress and unresolved issues of remote ischemic conditioning (pre-, per-, and post-conditioning) in treating acute ischemic stroke, with the hope of advancing our understanding of this promising neuroprotective strategy for ischemic stroke in the near future.

scholarly journals Remote Ischemic Conditioning With Exercise (RICE)—Rehabilitative Strategy in Patients With Acute Ischemic Stroke: Rationale, Design, and Protocol for a Randomized Controlled Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhenzhen Han ◽  
Wenbo Zhao ◽  
Hangil Lee ◽  
Melissa Wills ◽  
Yanna Tong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Controlled Trial ◽  
Walking Ability ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Randomized Controlled ◽  
Symptom Exacerbation

Objective: Exercise rehabilitation is an effective therapy in reducing the disability rate after stroke and should be carried out as early as possible. However, very early rehabilitation exercise exacerbates brain injury and is difficult to conduct in stroke patients due to their weakened and potentially disabled state. It is valuable to explore additional early rehabilitation strategies. Remote Ischemic Conditioning (RIC) is a novel therapy designed to protect vital organs from severe lethal ischemic injury by transient sublethal blood flow to non-vital organs, including the distal limbs, in order to induce endogenous protection. RIC has previously been conducted post-stroke for neuroprotection. However, whether combined early RIC and exercise (RICE) therapy enhances stroke rehabilitation remains to be determined.Methods: This is a single-center, double-blinded, randomized controlled trial that will enroll acute ischemic stroke patients within 24 h of symptom onset or symptom exacerbation. All enrolled patients will be randomly assigned to either the RICE group (exercise with RIC) or the control group (exercise with sham RIC) at a ratio of 1:1, with 20 patients in each group. Both groups will receive RIC or sham RIC within 24 h after stroke onset or symptom exacerbation, once a day, for 14 days. All patients will begin exercise training on the fourth day, twice a day, for 11 days. Their neurological function [Modified Rankin Scale (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index, and walking ability], infarct volume (nuclear magnetic resonance, MRI), and adverse events will be evaluated at different time points in their post-stroke care.Results: The primary outcome is safety, measured by the incidence of any serious RICE-related adverse events and decreased adverse events during hospitalization. The secondary outcome is a favorable prognosis within 90 days (mRS score < 2), determined by improvements in the mRS score, NIHSS score, Barthel Index, walking ability after 90 days, and infarct volume after 12 ± 2 days.Conclusion: This study is a prospective randomized controlled trial to determine the rehabilitative effect of early RIC followed by exercise on patients with acute ischemic stroke.Trial Registration:www.chictr.org.cn, identifier: ChiCTR2000041042

scholarly journals Factors That Influence Compliance to Long-Term Remote Ischemic Conditioning Treatment in Patients With Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Jie Zhao ◽  
Kaiting Fan ◽  
Wenbo Zhao ◽  
Hui Yao ◽  
Jiayue Ma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Patient Compliance ◽  
Treatment Compliance ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Four Dimensions ◽  
Ischemic Cerebrovascular Disease ◽  
Conditioning Treatment ◽  
History Of ◽  
Psychological Dimensions

Objectives: To investigate the treatment compliance of patients with ischemic stroke to remote ischemic conditioning (RIC) and to determine the factors that influence compliance.Methods: We conducted a retrospective study of patients with ischemic stroke who were treated with RIC. Treatment compliance was determined and analyzed in patients who had received 1 year of RIC training. Factors that influenced patient compliance were also determined using univariate and multivariate regression analyses.Results: Between March 2017 and February 2018, 91 patients were recruited into this study. The mean (±SD) age was 57.98 ± 10.76 years, and 78 (85.7%) patients were male. The baseline Kolcaba comfort scale of patients with good compliance scores were higher than those with poor compliance. The scores of the four dimensions in the scale and the total score are as follows: physiological dimensions, 15.0 (12.0,17.0) vs 17.0 (13.0,19.0); psychological dimensions, 30.0 (25.0,34.0) vs 31.0 (27.0,35.0); sociological dimensions, 20.0 (18.0,24.0) vs 21.0 (18.0,23.0); environmental dimensions, 19.0 (12.0,24.0) vs 20.0 (17.0,22.0); and total points, 82.0 (69.0,94.0) vs 91.0 (78.0,98.0). the differences between the groups were significant (p < 0.05), except for the sociological dimensions. A history of hypertension, number of follow-ups, and the physiological, psychological, and environmental dimensions of the comfort scale were related to patient compliance, out of which the number of follow-ups (Adjusted OR = 2.498, 95% confidence interval (CI) 1.257–4.964) and the physiological discomfort (Adjusted OR = 1.128, 95% CI 1.029–1.236) independently influenced compliance (p < 0.05).Conclusion: In patients with ischemic cerebrovascular disease who were treated with RIC, the number of follow-up visits and physiological discomfort associated with RIC treatment independently influenced patient compliance. Further studies are needed to investigate the RIC protocols and their corresponding nursing models.

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