Ischemic Postconditioning in Patients With Acute Stroke With Successful Recanalization After Endovascular Therapy: A...

Area of Science:

• Neurology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Ischemia-reperfusion injury exacerbates stroke damage even after successful recanalization.
• Ischemic postconditioning (IPostC) is a preclinical strategy to reduce infarct size.
• The clinical efficacy of IPostC as an adjunct to endovascular thrombectomy for acute ischemic stroke is not well-established.

Purpose of the Study:

• To evaluate the therapeutic effect of IPostC in reducing infarct growth in acute ischemic stroke patients.
• To determine if IPostC, applied after successful recanalization, can limit infarct expansion.
• To assess the impact of IPostC on infarct volume and clinical outcomes.

Main Methods:

• A single-center, prospective, randomized, open-label trial with blinded end point assessment was conducted.
• Patients with acute ischemic stroke undergoing successful endovascular thrombectomy were randomized to IPostC or control.
• IPostC involved cycles of balloon inflation/deflation at the occlusion site; primary outcome was infarct growth at 48-hour MRI.

Main Results:

• IPostC significantly reduced infarct growth from baseline to 48-hour MRI compared to the control group (median difference: -8.7 mL, P=0.015).
• Early infarct growth was also lower in the IPostC group (P=0.045).
• Patients receiving IPostC showed improved National Institutes of Health Stroke Scale scores at 24 hours (P=0.005), but 90-day functional outcomes did not differ significantly.

Conclusions:

• IPostC performed after successful recanalization is a promising adjunctive therapy for reducing infarct growth in acute ischemic stroke.
• These pilot findings suggest IPostC may limit stroke progression and improve early neurological deficits.
• Larger randomized trials are necessary to confirm these results and establish the role of IPostC in stroke management.