Presenter of 1 Presentation
LONG-TERM REMOTE ISCHEMIC CONDITIONING IN PATIENTS WITH ISCHEMIC STROKE – A RANDOMIZED CONTROLLED CROSS-OVER TRIAL
Abstract
Background and Aims
Remote ischemic conditioning (RIC) may have neuroprotective effects. Immediate or long-term RIC may increase cerebral blood flow velocity and cerebrovascular reactivity in patients with ischemic stroke.
Methods
We included patients with cerebral small vessel occlusion stroke in a randomized controlled, open-label, outcome-blinded, cross-over pilot study, with two weeks daily RIC treatment (four cycles of five minutes) and two weeks observation, intersected by three weeks wash-out. At baseline and after each period mean cerebral blood flow velocity in the middle cerebral artery (VMCA) was assessed by transcranial doppler and blood oxygen saturation in the cerebral microvasculature (ScO2) by near infrared spectroscopy (NIRS) at rest, during RIC and finger tapping. Blood pressure (BP) and ankle brachial index (ABI) were recorded. Cognitive function and modified Rankin Score were assessed at baseline.
Results
14 patients, mean age 71±8.1 years, 21% women, NIHSS on admission 3±3.2. Baseline mean values ± SD were; MOCA 26±2.3, VMCA 48.8±8.5 cm/sec, ScO2 68.3±5.7, BP 137/80±18/8 mmHg, ABI 1.08±0.1. VMCA (p=0.50) or ScO2 (p=0.25) did not change during RIC or after each period (p=0.28/p=0.53, VMCA/ScO2 respectively). Finger tapping increased VMCA mean by 4.13% ±6.31 (p=0.029) and ScO2 mean by 0.37% ±0.50 (p=0.02), with no excess change between periods (p=0.9 and 0.96). No change in BP (p=0.68) or ABI (p=0.53).
Conclusions
Cerebrovascular response remained unchanged during RIC and after two weeks daily RIC. RIC did no change peripheral vascular response. More sensitive methods of measuring cerebral blood flow should be applied to evaluate if RIC may improve vascular outcome after ischemic stroke.