Remote ischemic conditioning prevents ischemic cerebrovascular events in children with moyamoya disease: a randomized
Shuang-Feng Huang1, Jia-Li Xu1,2, Chang-Hong Ren3,4
1Department of Neurology, Xuanwu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.
Insights
Remote ischemic conditioning (RIC) shows promise for reducing major adverse cerebrovascular events in children with Moyamoya disease (MMD). This safe and effective therapy improved clinical outcomes, offering a new treatment avenue for pediatric stroke prevention.
Area of Science:
- Neurology
- Pediatric Stroke
- Cardiovascular Research
Background:
- Moyamoya disease (MMD) is a leading cause of stroke and transient ischemic attacks (TIAs) in children.
- There is a need for effective, non-invasive therapies to prevent cerebrovascular events in pediatric MMD patients.
Purpose of the Study:
- To evaluate the safety and efficacy of remote ischemic conditioning (RIC) as an adjunct therapy for children diagnosed with MMD.
- To assess the impact of RIC on the incidence of major adverse cerebrovascular events (MACEs) and clinical improvement in pediatric MMD.
Main Methods:
- A single-center pilot study randomized 46 pediatric MMD patients (ages 4-14) to receive either RIC or sham RIC treatment for one year.
- Primary endpoint was the cumulative incidence of MACEs; secondary endpoints included stroke, TIAs, revascularization, and clinical improvement (PGIC scale).
- Cerebral hemodynamics were assessed using transcranial Doppler, and RIC-related adverse events were monitored.
Main Results:
- No severe adverse events were associated with RIC treatment.
- Kaplan-Meier analysis revealed a significant reduction in MACEs frequency in the RIC group (P=0.021).
- The RIC group demonstrated a higher clinical improvement rate (65.2% vs. 26.1%, P<0.01) on the PGIC scale compared to the sham group.
Conclusions:
- Remote ischemic conditioning (RIC) is a safe and effective adjunctive therapy for asymptomatic children with Moyamoya disease.
- RIC significantly reduces the incidence of ischemic cerebrovascular events, contributing to improved clinical outcomes in pediatric MMD.
Background:
Moyamoya disease (MMD) is a significant cause of childhood stroke and transient ischemic attacks (TIAs). This study aimed to assess the safety and efficacy of remote ischemic conditioning (RIC) in children with MMD.
Methods:
In a single-center pilot study, 46 MMD patients aged 4 to 14 years, with no history of reconstructive surgery, were randomly assigned to receive either RIC or sham RIC treatment twice daily for a year. The primary outcome measured was the cumulative incidence of major adverse cerebrovascular events (MACEs). Secondary outcomes included ischemic stroke, recurrent TIA, hemorrhagic stroke, revascularization rates, and clinical improvement assessed using the patient global impression of change (PGIC) scale during follow-up. RIC-related adverse events were also recorded, and cerebral hemodynamics were evaluated using transcranial Doppler.
Results:
All 46 patients completed the final follow-up (23 each in the RIC and sham RIC groups). No severe adverse events associated with RIC were observed. Kaplan-Meier analysis indicated a significant reduction in MACEs frequency after RIC treatment [log-rank test (Mantel-Cox), P = 0.021]. At 3-year follow-up, two (4.35%) patients had an ischemic stroke, four (8.70%) experienced TIAs, and two (4.35%) underwent revascularization as the qualifying MACEs. The clinical improvement rate in the RIC group was higher than the sham RIC group on the PGIC scale (65.2% vs. 26.1%, P < 0.01). No statistical difference in cerebral hemodynamics post-treatment was observed.
Conclusions:
RIC is a safe and effective adjunct therapy for asymptomatic children with MMD. This was largely due to the reduced incidence of ischemic cerebrovascular events.
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