Chronic remote ischemic conditioning for symptomatic internal carotid or middle cerebral artery occlusion: A
Sijie Li1,2, Wenbo Zhao2,3, Guiyou Liu1
1Department of Emergency, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
Insights
Remote ischemic conditioning (RIC) is safe for patients with carotid or middle cerebral artery occlusion. This chronic treatment shows a low annual risk of stroke and cardiovascular events in these high-risk individuals.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Remote ischemic conditioning (RIC) shows promise in reducing recurrent stroke in patients with intracranial artery stenosis.
- Symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion with impaired hemodynamics represents a significant risk for cerebrovascular events.
Purpose of the Study:
- To evaluate the efficacy and safety of chronic remote ischemic conditioning (RIC) in patients experiencing symptomatic ICA or MCA occlusion.
- To assess the long-term risk of cardio-cerebrovascular events in this patient cohort undergoing RIC.
Main Methods:
- A prospective cohort study was conducted at a single high-volume center in China.
- 131 patients with symptomatic ICA or MCA occlusion and impaired hemodynamics received chronic RIC.
- Regular clinical follow-ups assessed cardio-cerebrovascular events over a mean of 8.8 years.
Main Results:
- The study included 131 patients (68 ICA, 63 MCA occlusion), with a mean age of 52.6 years.
- RIC compliance was high (95.6%) with no severe adverse events reported.
- The annual risk of ischemic stroke was 2.4%, and ischemic cerebrovascular events was 3.3%.
Conclusions:
- Chronic RIC is well-tolerated in patients with symptomatic ICA or MCA occlusion and impaired hemodynamics.
- RIC appears to be associated with a low annual risk of ischemic stroke and cardio-cerebrovascular events.
- Long-term cumulative event rates suggest a potential protective effect of RIC in this population.
Aims:
Remote ischemic conditioning (RIC) has been demonstrated to reduce recurrent stroke in patients with intracranial artery stenosis. This study aimed to evaluate the effects of RIC in patients with the symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.
Methods:
This study is based on a high-volume single-center prospective cohort study in China, which included patients with symptomatic ICA or MCA occlusion with impaired hemodynamics and receiving chronic RIC. Clinical follow-up visits were performed regularly, and cardio-cerebrovascular events were assessed.
Results:
In total, 131 patients (68 with ICA occlusion and 63 with MCA occlusion; mean age, 52.6 ± 13.7 years; stroke, 73.5%; transient ischemic attack TIA, 26.5%) qualified for the analysis; the mean follow-up period was 8.8 years (range, 3-14 years). The compliance of RIC was 95.6 ± 3.7%, and no associated severe adverse events happened. The annual risk of ischemic stroke and ischemic cerebrovascular events was 2.4% and 3.3%, respectively. The cumulative probabilities of ischemic cerebrovascular events and major adverse cardiovascular and cerebrovascular events were 32.8% and 44.8% at 14 years, respectively.
Conclusion:
In patients with symptomatic ICA or MCA occlusion with impaired hemodynamics, chronic RIC is well-tolerated, and it appears to be associated with a low annual risk of ischemic stroke and cardio-cerebrovascular events.
More Related Videos
09:11Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
Published on: February 23, 2016
04:18Author Spotlight: A Novel Approach to Cerebral Ischemia Modeling – Enhancing Reperfusion and Simplifying Procedure
Published on: May 31, 2024