Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning

Yannopoulos, Fredrik; Mäkelä, Tuomas; Niemelä, Eija; Tuominen, Hannu; Lepola, Pasi; Alestalo, Kirsi; Kaakinen, Hanna; Kiviluoma, Kai; Anttila, Vesa; Juvonen, Tatu

doi:10.1016/j.athoracsur.2010.03.058

Cited by 19 publications

(8 citation statements)

References 22 publications

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“…The duration of our BAIPC treatments span a much longer period. Our prolonged approach may be consistent with studies suggesting that long-term (weeks or years) protection may be achieved by repeated doses of preconditioning [11,39,40]. Future studies should examine different protocols to find the optimal treatment timing and doses.…”

Section: Discussionsupporting

confidence: 80%

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

et al. 2015

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Symptomatic intracranial arterial stenosis (SIAS) is very common in octo-and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo-and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo-and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (n=30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (n=28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all p<0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (p<0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo-and nonagenarians with SIAS. A multicenter trial is ongoing.Clinical Trial Registration: www.clinicaltrials.gov, unique identifier: NCT01570231.

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Section: Discussionsupporting

confidence: 80%

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

et al. 2015

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“…25 Its potential has been strengthened by our recent findings in an acute porcine model of HCA, where RIPC provided a faster recovery of cortical neuronal activity, protection against potential cerebral oxygen radical-mediated ischemia damage, and a decrease in late-phase lactate and pyruvate burst in the brain, mitigating possible damage from an anaerobic metabolism phase. 26 The present study demonstrates that the neuroprotective effect after a series of blood pressure cuff inflations before HCA in a surviving-animal model was associated with a significant reduction in some important markers of neurological injury, accelerating neurological recovery and mitigating histopathological findings. RIPC might be neuroprotective in patients undergoing surgery with HCA and improve longterm outcomes.…”

Section: Discussionmentioning

confidence: 81%

Remote Ischemic Preconditioning Protects the Brain Against Injury After Hypothermic Circulatory Arrest

et al. 2011

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Background-Ischemic preconditioning (IPC) is a mechanism protecting tissues from injury during ischemia and reperfusion. Remote IPC (RIPC) can be elicited by applying brief periods of ischemia to tissues with ischemic tolerance, thus protecting vital organs more susceptible to ischemic damage. Using a porcine model, we determined whether RIPC of the limb is protective against brain injury caused by hypothermic circulatory arrest (HCA). Methods and Results-Twelve piglets were randomized to control and RIPC groups. RIPC was induced in advance of cardiopulmonary bypass by 4 cycles of 5 minutes of ischemia of the hind limb. All animals underwent cardiopulmonary bypass followed by 60 minutes of HCA at 18°C. Brain metabolism and electroencephalographic activity were monitored for 8 hours after HCA. Assessment of neurological status was performed for a week postoperatively. Finally, brain tissue was harvested for histopathological analysis. Study groups were balanced for baseline and intraoperative parameters. Brain lactate concentration was significantly lower (PϽ0.0001, ANOVA) and recovery of electroencephalographic activity faster (PϽ0.05, ANOVA) in the RIPC group. RIPC had a beneficial effect on neurological function during the 7-day follow-up (behavioral score; PϽ0.0001 versus control, ANOVA). Histopathological analysis demonstrated a significant reduction in cerebral injury in RIPC animals (injury score; mean [

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“…10,15 During the last decade, we have observed a neuroprotective effect of RIPC in ischemic brain injury associated with hypothermic circulatory arrest. 13,16 However, evidence has been found against the protective effect, when the RIPC is performed in children suffering from chronic hypoxia. 17 In this context, the chronic hypoxia may cover the effect of RIPC.…”

Section: Discussionmentioning

confidence: 99%

Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model

Haapanen

Herajärvi

Arvola

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning

Cited by 19 publications

References 22 publications

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

Remote Ischemic Preconditioning Protects the Brain Against Injury After Hypothermic Circulatory Arrest

Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model

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