Remote limb ischemic conditioning treatment for intracranial atherosclerotic stenosis patients

Abstract

We predict that RLIC treatment for 12 months will safely reduce the ischemic stroke recurrence rate.

Remote ischemic conditioning: a promising therapeutic intervention for multi-organ protection

“…(1) Acute ischemic stroke [ 146 , 147 ], RIC treatment after acute stroke was likely to lower the risk of tissue infarction after 1 month, and improve the neurological outcome as depicted by a reduction in day 90 median National Institutes of Health Stroke Scale (NIHSS) score; (2) chronic cerebral ischemia [ 142 , 143 , 148 , 149 ], daily use of bilateral upper limb RIC was safe, tolerable, and able to reduce the recurrence of stroke/transient ischemic attack (TIA), improve cerebral perfusion as well as ameliorate the processes of inflammation, coagulation and fibrinolysis; (3) subarachnoid hemorrhage [ 150 – 155 ], the feasibility and tolerability of RIC were denoted in several proof-of-concept trials; (4) carotid endarterectomy and stenting (CEA and CAS) [ 156 , 157 ], a trend toward fewer saccadic latency deteriorations and a significant reduction in the incidence of new DWI lesions were observed among patients who received RIC; (5) cerebral small-vessel disease [ 158 – 160 ], RIC appeared to be effective in retarding cognition decline and decreasing white matter lesions; and (6) traumatic brain injury [ 161 ], it was found that RIC markedly reduced the serum levels of neuron-specific enolase (NSE) and S-100β.…”

Very Delayed Remote Ischemic Post-conditioning Induces Sustained Neurological Recovery by Mechanisms Involving Enhanced Angioneurogenesis and Peripheral Immunosuppression Reversal

“…The concept of remote conditioning in general and the concept of rPostC in particular are interesting concepts for adjuvant treatment paradigms of different diseases. Indeed, first clinical trials have been performed, suggesting possible beneficial effects after remote conditioning ( Zuo et al, 2015 ; Bei et al, 2016 ; Hou et al, 2016 ; England et al, 2017 ; Wang et al, 2017 ; Zhao et al, 2017 ; Zhou et al, 2017 ). Yet, the study concepts are heterogeneous, including small study populations with special medical conditions only.…”

“…Yet, the study concepts are heterogeneous, including small study populations with special medical conditions only. Leaving aside clinical trials on various settings of renal malfunction ( Bei et al, 2016 ; Zuo et al, 2015 ; Zhou et al, 2017 ) as well as trials on chronic vessel diseases of the brain ( Hou et al, 2016 ; Wang et al, 2017 ; Zhao et al, 2017 ), the RECAST study remains the only clinical trial where rPostC has been applied as a therapeutic means to counter a territorial ischemic stroke during the acute phase of the disease ( England et al, 2017 ). Of note, rPostC in the RECAST trial like in the RESCUE BRAIN trial, which is currently recruiting ( Pico et al, 2016 ), treatment starts within 24 h post-stroke.…”

“…Indeed, rPostC in general and hind limb rPostC in particular has been shown to be neuroprotective, albeit survival periods of these studies did not extend 2 weeks, giving insights in some underlying cellular signaling pathways only ( Hasseldam et al, 2013 ; Li S. et al, 2015 ; Ren et al, 2015 , 2018 ; Ramagiri and Taliyan, 2017a , b ). Although first clinical trials with regard to rPostC in stroke-like settings are underway with indication of both a putative beneficial effect and safety ( Hou et al, 2016 ; England et al, 2017 ; Wang et al, 2017 ; Zhao et al, 2017 ), further pre-clinical studies are urgently needed in order to address fundamental issues. As a matter of fact, the RECAST trial remains the only trial using rPostC as a tool for acute stroke treatment, whereas other trials focus on the impact of rPostC on conditions of chronic vessel disease only.…”

Potential Applications of Remote Limb Ischemic Conditioning for Chronic Cerebral Circulation Insufficiency

“…In addition to its protective effects in the heart and brain, RLIC has been shown to exert protective effects in several other organs such as the lungs, kidneys, and liver (24). While RLIC applications are currently limited to cases of acute ischemia, recent studies have revealed the protective effects of RLIC against the effects of chronic decreases in blood supply in the brain (8, 9, 25–27) and heart (28), such as those associated with CCCI and stable coronary artery disease.…”