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Remote Ischemic Conditioning: Challenges and Opportunities
Wenbo Zhao1, Derek J Hausenloy2,3,4,5, David C Hess6
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (W.Z.).
Insights
Remote ischemic conditioning (RIC) shows promise for cerebrovascular disease but has limited cardiovascular applications. Future research should focus on chronic RIC, early intervention, and biomarkers for clinical use.
Area of Science:
- Cardiovascular and Cerebrovascular Diseases
- Non-pharmacological Interventions
- Ischemic Conditioning
Background:
- Remote ischemic conditioning (RIC) has been explored for cardio-cerebrovascular diseases for 30 years.
- RIC has yielded variable results, with limited success in cardiovascular disease but recent promising findings in cerebrovascular disease.
Purpose of the Study:
- To review clinical trials of RIC in cardio-cerebrovascular disease.
- To discuss challenges in the clinical translation of RIC.
- To propose future research directions for RIC.
Main Methods:
- Review of clinical trials and existing literature on RIC.
- Analysis of challenges in implementing RIC in clinical practice.
- Identification of potential areas for future research.
Main Results:
- Milestone studies suggest limited roles for RIC in cardiovascular disease.
- Recent large trials show promising results for RIC in cerebrovascular disease.
- Significant challenges exist in the clinical translation of RIC.
Conclusions:
- RIC shows potential for cerebrovascular disease, warranting further investigation.
- Future research should explore chronic RIC, early initiation, compliance, dosing, and biomarkers.
- Further studies are needed before RIC can be widely applied in clinical practice.
Abstract:
Remote ischemic conditioning (RIC) has been investigated as a promising, safe, and well-tolerated nonpharmacological therapy for cardio-cerebrovascular disease over the past 3 decades; variable results have been found when it is used in cerebrovascular versus cardiovascular disease. For patients with cardiovascular disease, milestone studies suggest that the roles of RIC may be limited. Recently, however, 2 large trials investigating RIC in patients with cerebrovascular disease found promising results, which may reignite the field's research prospects after its setbacks in the cardiovascular field. This perspectives article highlights several important clinical trials of RIC in the cardio-cerebrovascular disease and describes the many challenges of RIC in clinical translation. Finally, based on the available evidence, several promising research directions such as chronic RIC, early initiation in target population, improvement of compliance, better understanding of dosing, and identification of specific biomarkers are proposed and should be investigated before RIC can become applied into clinical practice for patient benefit.
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