Peripheral vascular disease as remote ischemic preconditioning, for acute stroke

Area of Science:

• Neurology
• Vascular Medicine
• Ischemic Stroke Research

Background:

• Remote ischemic preconditioning (RIPC) protects tissues from ischemic injury, but its effects in human acute cerebral ischemia are understudied.
• Chronic peripheral hypoperfusion from peripheral vascular disease (PVD) has not been explored for potential neuroprotective effects in stroke.

Purpose of the Study:

• To investigate if chronic peripheral hypoperfusion due to untreated peripheral vascular disease (PVD) confers neuroprotection in patients with acute ischemic stroke.
• To compare stroke outcomes in patients with PVD versus a matched control group.

Main Methods:

• Identified patients with untreated PVD from a stroke registry and matched them with a control group based on demographics and risk factors.
• Compared outcomes using NIH Stroke Scale (NIHSS), modified Rankin scale (mRS), mortality, and infarct volume at admission and discharge.

Main Results:

• The PVD group (n=26 pairs) showed significantly lower admission NIHSS scores (47.1% vs 4.35%, p<0.003).
• PVD patients had more favorable discharge mRS scores (30.8% vs 3.84%, p<0.012) and significantly lower mortality (26.9% vs 57.7%, p=0.024).
• Mean infarct volume was significantly lower in the PVD group at both admission (39.6 mL vs 148.3 mL, p<0.005) and discharge (111.7 mL vs 275 mL, p<0.001).

Conclusions:

• Chronic limb hypoperfusion associated with PVD may exert a neuroprotective effect in acute ischemic stroke.
• This observed neuroprotection mirrors findings from preclinical models of remote ischemic preconditioning (RIPC).