Conditioning medicine for ischemic and hemorrhagic stroke
David C Hess1, Mohammad Badruzzaman Khan1, Pradip Kamat1
1Department of Neurology, Medical College of Georgia, Augusta, GA.
Conditioning Medicine
|August 20, 2021
Summary
Remote ischemic conditioning (RIC) offers a safe, feasible, and inexpensive prehospital treatment for acute stroke. This method may improve cerebral blood flow (CBF) and is being investigated for its effectiveness and mechanism of action.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Remote ischemic conditioning (RIC) is a safe, feasible, and cost-effective intervention for acute stroke.
- RIC involves using a blood pressure cuff on limbs, making it suitable for prehospital care.
- It shares similarities with physical exercise and acts as a "collateral therapeutic".
Purpose of the Study:
- To evaluate the safety and efficacy of RIC in acute stroke patients.
- To investigate the role of nitric oxide/nitrite metabolism in mediating RIC's effects.
- To assess RIC's potential to improve collateral cerebral blood flow (CBF).
Main Methods:
- The RESIST trial is a multicenter, randomized, sham-controlled study.
- Involves 1500 subjects in a prehospital setting in Denmark.
- Utilizes a blood pressure cuff applied to the limbs for RIC intervention.
Main Results:
- RIC demonstrated potential for improving collateral cerebral blood flow (CBF).
- Mechanisms may involve nitric oxide synthase 3 in endothelium and circulating blood cells.
- The RESIST trial aims to confirm safety and effectiveness in acute stroke.
Conclusions:
- RIC is a promising intervention for acute stroke, applicable in prehospital settings.
- Further research, including the RESIST trial, is crucial to validate its clinical utility.
- Understanding the role of nitric oxide/nitrite metabolism is key to optimizing RIC therapy.
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