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In situ ischemic postconditioning for acute ischemic stroke: preliminary exploratory study.

Xiao Jiang1, Longfei Wu2, Shuling Liu3

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Ischemic postconditioning (IPostC) after stroke thrombectomy may reduce deep infarct volume and modulate immune responses. Further trials are needed to confirm these neuroprotective effects in acute ischemic stroke patients.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Immunology

Background:

  • Endovascular therapy is effective for acute ischemic stroke, but outcomes vary.
  • Ischemic postconditioning (IPostC) shows potential neuroprotection in preclinical models but lacks human data.
  • This study investigated in situ IPostC's effect on infarct volume after mechanical thrombectomy.

Purpose of the Study:

  • To evaluate the impact of in situ ischemic postconditioning (IPostC) on infarct volume in acute ischemic stroke patients undergoing mechanical thrombectomy.
  • To assess the immunomodulatory effects of IPostC by analyzing leukocyte populations and inflammatory biomarkers.

Main Methods:

  • A prospective, externally controlled, non-randomized trial comparing in situ IPostC plus thrombectomy to thrombectomy alone.
  • Propensity score matching (PSM) was used to minimize bias, with 19 patients per group analyzed.
  • Primary outcome was infarct volume at 72 hours; secondary outcomes included deep infarct volume, leukocyte subsets, and serum inflammatory markers.

Main Results:

  • The IPostC group demonstrated significantly reduced deep infarct volume progression (2.3 vs 4.7 mL).
  • IPostC was associated with lower interleukin-6 levels (26.4 vs 32.6 pg/mL) and reduced natural killer cell proportions (1.10% vs 1.68%).
  • Higher Th/CTL ratios (2.04 vs 1.65) were observed in the IPostC group.

Conclusions:

  • In situ IPostC following mechanical thrombectomy for large vessel occlusion stroke may reduce deep infarct volume progression.
  • IPostC appears to have favorable immunomodulatory effects, including reduced inflammation and altered T-cell/NK cell balance.
  • Further validation in phase II trials is warranted to confirm the efficacy and safety of IPostC.