Immediate remote ischemic postconditioning reduces cerebral damage in ischemic stroke mice by enhancing leptomeningeal collateral circulation

Zhang, Ying; Ma, Longhui; Ren, Chang­hong; Liu, Kaiyin; Tian, Xin; Wu, Di; Ding, Yuchuan; Li, Junfa; Borlongan, Cesar V.; Ji, Xunming

doi:10.1002/jcp.27858

Cited by 31 publications

(24 citation statements)

References 39 publications

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“…Collateral status correlates with stroke severity and reperfusion outcomes, due to their ability to restrict the growth of penumbral territory [44]. Although the underlying mechanisms of RIC are still not fully known, some recent preclinical studies have showed an enhancement of collateral circulation [45,46]. For that, the role of collaterals is essential in large vessel occlusion (LVO) patients, whom are also candidates to undergo mechanical thrombectomy [47,48] in admitted hospital, or they are candidates to be transferred to a Comprehensive Stroke center.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

et al. 2020

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Background: Remote ischemic conditioning during cerebral ischemia (remote ischemic perconditioning, RIPerC) refers to the application of several cycles of brief ischemia and reperfusion (I/R) commonly to a limb, and it represents a new paradigm in neuroprotection with multiple mechanisms of action in ischemic stroke (IS) patients during acute phase. Some clinical trials just finished, and a few others are still ongoing; gather the current knowledge and pull it down to influence the present and future studies was the goal of this paper. Methods: A systematic review of published research papers and/or registered clinical trials since 2000 was performed. Results: Nineteen studies were identified and only four studies were completed. All of them have demonstrated that RIPerC is safe, feasible and well tolerated in IS patients. However, a high heterogeneity of clinical trial characteristics was observed: five (26.3%) randomized clinical trials (RCTs) included only thrombolytic-treated patients, three (15.8%) RCTs only thrombectomy-treated patients, and five (26.3%) RCTs required radiological confirmation of IS. Temporal inclusion criteria vary from 4 h to 48 h. Most of the clinical trials used 4 cycles of RIPerC in the upper non-affected limb. Interestingly, only three (16.7%) RCTs applied RIPerC during the transportation in the ambulance. Neuroimaging outputs were the main endpoints when endovascular therapy was applied; functional outcome is also the main endpoint in large-medium size studies. Conclusions: This review summarizes the completed and ongoing clinical trials on RIPerC in IS patients, where RIPerC has been used alone or in combination with recanalization therapies. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and potentially improve the functional outcome of IS patients; definition of new RIPerC strategies would ideally aim at enhancing tissue preservation, promoting neurological recovery, and stratify patients to improve treatment feasibility.

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Section: Implications For Future Researchmentioning

confidence: 99%

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

et al. 2020

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“…RIC may play a neuroprotective role by enhancing the leptomeningeal collateral circulation. 64 In addition, it has been reported that RIC significantly induced angiogenesis and collaterals formation, which was manifested as an increase in the number and volume of blood vessels. And these changes had an effect on improving CBF.…”

Section: Ric Can Improve Cerebral Collateral Circulationmentioning

confidence: 99%

<p>Effects of Remote Ischemic Conditioning on Cerebral Hemodynamics in Ischemic Stroke</p>

Chen¹,

Yan²,

Jin³

et al. 2020

NDT

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Ischemic stroke is one of the most common cerebrovascular diseases and is the leading cause of disability all over the world. It is well known that cerebral blood flow (CBF) is disturbed or even disrupted when ischemic stroke happens. The imbalance between demand and shortage of blood supply makes ischemic stroke take place or worsen. The search for treatments that can preserve CBF, especially during the acute phase of ischemic stroke, has become a research hotspot. Animal and clinical experiments have proven that remote ischemic conditioning (RIC) is a beneficial therapeutic strategy for the treatment of ischemic stroke. However, the mechanism by which RIC affects CBF has not been fully understood. This review aims to discuss several possible mechanisms of RIC on the cerebral hemodynamics in ischemic stroke, such as the improvement of cardiac function and collateral circulation of cerebral vessels, the protection of neurovascular units, the formation of gas molecules, the effect on the function of vascular endothelial cells and the nervous system. RIC has the potential to become a therapeutic treatment to improve CBF in ischemic stroke. Future studies are needed to highlight our understanding of RIC as well as accelerate its clinical translation.

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“…Although the underlying mechanisms of RIC are still not fully known, some recent preclinical studies have showed an enhancement of collateral circulation (46,47). For that, the role of collaterals is essential in large vessel occlusion (LVO) patients, whom are also candidates to undergo mechanical thrombectomy (48,49) in admitted hospital, or they are candidates to be transferred to a Comprehensive Stroke center.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

Purroy

García

Mauri

et al. 2020

Preprint

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Abstract Background: Remote ischemic conditioning during cerebral ischemia (remote ischemic perconditioning, RIPerC) refers to the application of several cycles of brief ischemia and reperfusion (I/R) commonly to a limb, and it represents a new paradigm in neuroprotection with multiple mechanisms of action in ischemic stroke (IS) patients during acute phase. Some clinical trials just finished, and a few others are still ongoing; gather the current knowledge and pull it down to influence the present and future studies was the goal of this paper. Methods: A systematic review of published research papers and/or registered clinical trials since 2000 was performed. Results: Nineteen studies were identified and only four studies were completed. All of them have demonstrated that RIPerC is safe, feasible and well tolerated in IS patients. However, a high heterogeneity of clinical trial characteristics was observed: five (26.3%) randomized clinical trials (RCTs) included only thrombolytic-treated patients, three (15.8%) RCTs only thrombectomy-treated patients, and five (26.3%) RCTs required radiological confirmation of IS. Temporal inclusion criteria vary from 4h to 48h. Most of the clinical trials used 4 cycles of RIPerC in the upper non-affected limb. Interestingly, only three (16.7%) RCTs applied RIPerC during the transportation in the ambulance. Neuroimaging outputs were the main endpoints when endovascular therapy was applied; functional outcome is also the main endpoint in large-medium size studies. Conclusions: This review summarizes the completed and ongoing clinical trials on RIPerC in IS patients, where RIPerC has been used alone or in combination with recanalization therapies. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and potentially improve the functional outcome of IS patients; definition of new RIPerC strategies would ideally aim at enhancing tissue preservation, promoting neurological recovery, and stratify patients to improve treatment feasibility.

show abstract

Immediate remote ischemic postconditioning reduces cerebral damage in ischemic stroke mice by enhancing leptomeningeal collateral circulation

Cited by 31 publications

References 39 publications

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

<p>Effects of Remote Ischemic Conditioning on Cerebral Hemodynamics in Ischemic Stroke</p>

Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review

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