The Potential of Chronic Remote Ischemic Conditioning in Cerebral Small Vessel Disease

Chronic remote ischemic conditioning (C-RIC) is the month-long or more intervention of RIC. C-RIC has shown promise in a large randomized clinical trial in intracranial atherosclerotic stenosis (ICAS) to reduce the risk of stroke. C-RIC has the potential to reduce cognitive impairment in cerebral small vessel disease (cSVD). C-RIC is effective in a preclinical model of vascular cognitive impairment and dementia (VCID), the bilateral carotid stenosis model in mice, at reducing cognitive impairment, and white matter damage. C-RIC is safe and shows promise in pilot clinical trials of cSVD. In cohort studies, physical exercise is effective at preventing stroke in ICAS and in slowing the progression of cognitive decline in cSVD. C-RIC shares common mechanisms with physical exercise and is an attractive therapy for cSVD. Dosing and compliance are two issues that need to be resolved before large phase II-III trials in cSVD can be optimized.