Chronic remote ischemic conditioning for symptomatic internal carotid or middle cerebral artery occlusion: A prospective cohort study

Abstract

Aims: Remote ischemic conditioning (RIC) has been demonstrated to reduce recurrent stroke in patients with intracranial artery stenosis. This study aimed to evaluate the effects of RIC in patients with the symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.Methods: This study is based on a high-volume single-center prospective cohort study in China, which included patients with symptomatic ICA or MCA occlusion with impaired hemodynamics and receiving chronic RIC. Clinical follow-up visits were performed regularly, and cardio-cerebrovascular events were assessed. Results:In total, 131 patients (68 with ICA occlusion and 63 with MCA occlusion; mean age, 52.6 ± 13.7 years; stroke, 73.5%; transient ischemic attack TIA, 26.5%) qualified for the analysis; the mean follow-up period was 8.8 years (range, 3-14 years).The compliance of RIC was 95.6 ± 3.7%, and no associated severe adverse events happened. The annual risk of ischemic stroke and ischemic cerebrovascular events was 2.4% and 3.3%, respectively. The cumulative probabilities of ischemic cerebrovascular events and major adverse cardiovascular and cerebrovascular events were 32.8% and 44.8% at 14 years, respectively. Conclusion:In patients with symptomatic ICA or MCA occlusion with impaired hemodynamics, chronic RIC is well-tolerated, and it appears to be associated with a low annual risk of ischemic stroke and cardio-cerebrovascular events.

Soluble lectin‐like oxidized low‐density Lipoproteinreceptor‐1 and recurrent stroke: A nested case–control study

“…In vivo studies, LOX‐1 expression is increased in experimental and clinical studies of hypertension, hyperlipidemia, type 2 diabetes mellitus, obesity, and carotid artery atherosclerosis 25–29 . Additionally, it was found that LOX‐1 is regulated by vasoconstrictive peptides, pro‐inflammatory cytokines, and other pathophysiological stimuli associated with atherosclerosis, which may play an important role in the recurrence of stroke 29–32 …”

“… 25 , 26 , 27 , 28 , 29 Additionally, it was found that LOX‐1 is regulated by vasoconstrictive peptides, pro‐inflammatory cytokines, and other pathophysiological stimuli associated with atherosclerosis, which may play an important role in the recurrence of stroke. 29 , 30 , 31 , 32 …”

“…[25][26][27][28][29] Additionally, it was found that LOX-1 is regulated by vasoconstrictive peptides, pro-inflammatory cytokines, and other pathophysiological stimuli associated with atherosclerosis, which may play an important role in the recurrence of stroke. [29][30][31][32] Our study has several limitations. First, this is a nested casecontrol study, with observations relation to prognostic value of sLOX-1 in recurrent stroke being particularly susceptible to confounding by selection bias.…”

Remote Ischemic Conditioning: Challenges and Opportunities

“…2 Chronic RIC demonstrated a sound safety profile, with no severe adverse events reported. 13,14 Given the protective time window of 1 RIC treatment and the clinical effects of chronic RIC in patients with cerebrovascular disease, investigating the clinical benefits of chronic or repeated daily RIC might be a better choice.…”

Bibliometric and visual analysis of cerebral revascularization from 1999 to 2022

“…In recent years, with the continuous in-depth study of imaging technology and clinical understanding of carotid artery occlusion, an increasing number of clinical researchers have gradually realized that hemodynamic disorders play a crucial role in cerebral ischemia caused by carotid artery occlusion ( Tsukada et al, 2022 ). The study revealed that among patients with carotid artery occlusion receiving drug treatment ( Li et al, 2020 , 2022 ), the annual incidence of ipsilateral ischemic stroke was 3%, but the annual incidence of stroke increased to 10–20% in patients with severe cerebral hemodynamic disorders. The enhancement of brain hemodynamics has therefore received considerable attention from researchers.…”