Remote ischemic conditioning for the treatment of ischemic moyamoya disease
Jia-Yue Ding1,2,3, Shu-Ling Shang1,4, Zhi-Shan Sun5
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Aims:
This study investigated the safety and efficacy of remote ischemic conditioning (RIC) on ameliorating the sequelae of ischemic moyamoya disease (iMMD).
Methods:
A total of 30 iMMD patients underwent long-term RIC and were followed up at 0.5, 1, and 2 years for clinical outcomes, including frequency of stroke recurrence, Patient Global Impression of Change (PGIC) scale, peak systolic velocities (PSV), and cerebral perfusion.
Results:
During the whole RIC treatment process, no RIC-related adverse event occurred. Only one of 30 patients suffered a onetime infarction (3.3%), and the ratios of acceptable PGIC were 88.2%, 64.3%, and 92.3% at 0.5, 1, and 2 years follow-up. Kaplan-Meier analysis showed the frequency of stroke recurrence was significantly reduced after RIC (P = .013). The frequency of TIA per week was 1.1 (0.6, 2.8) prior to RIC and 0.1 (0.0, 0.5) post-RIC (P < .01). Compared to baseline, PSV values were significantly reduced after RIC treatment (P = .002 at 0.5, P = .331 at 1, and P = .006 at 2 years). In patients undergoing perfusion studies, 75% obtained improvement on followed-up SPECT and 95% on followed-up PET maps.
Conclusions:
Remote ischemic conditioning may be beneficial on controlling iMMD-induced ischemic events, relieving symptoms, and improving cerebral perfusion, without incidence of complications in this case series.
Insights
Remote ischemic conditioning (RIC) is safe and effective for moyamoya disease, significantly reducing stroke recurrence and improving patient-reported outcomes and cerebral perfusion without complications.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Ischemic Stroke Research
Background:
- Moyamoya disease (iMMD) presents significant risks of stroke and neurological deficits.
- Effective therapeutic strategies to mitigate these risks are crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of remote ischemic conditioning (RIC) in patients with moyamoya disease (iMMD).
- To assess RIC's impact on stroke recurrence, clinical symptoms, and cerebral perfusion.
Main Methods:
- A cohort of 30 iMMD patients received long-term RIC.
- Clinical outcomes, including stroke recurrence, Patient Global Impression of Change (PGIC), peak systolic velocities (PSV), and cerebral perfusion, were monitored over 2 years.
Main Results:
- No adverse events related to RIC were reported.
- Stroke recurrence was significantly reduced (P=.013) with a notable decrease in Transient Ischemic Attacks (TIAs) frequency (P<.01).
- Improvements were observed in PGIC scores, PSV values, and cerebral perfusion as assessed by SPECT and PET imaging.
Conclusions:
- RIC demonstrates potential as a safe and beneficial intervention for iMMD.
- RIC may help control ischemic events, alleviate symptoms, and enhance cerebral perfusion in iMMD patients.
