Remote Ischemic Conditioning: Challenges and Opportunities

Abstract

Remote ischemic conditioning (RIC) has been investigated as a promising, safe, and well-tolerated nonpharmacological therapy for cardio-cerebrovascular disease over the past 3 decades; variable results have been found when it is used in cerebrovascular versus cardiovascular disease. For patients with cardiovascular disease, milestone studies suggest that the roles of RIC may be limited. Recently, however, 2 large trials investigating RIC in patients with cerebrovascular disease found promising results, which may reignite the field’s research prospects after its setbacks in the cardiovascular field. This perspectives article highlights several important clinical trials of RIC in the cardio-cerebrovascular disease and describes the many challenges of RIC in clinical translation. Finally, based on the available evidence, several promising research directions such as chronic RIC, early initiation in target population, improvement of compliance, better understanding of dosing, and identification of specific biomarkers are proposed and should be investigated before RIC can become applied into clinical practice for patient benefit.

Remote ischemic conditioning improves cerebral hemodynamics in symptomatic intracranial atherosclerosis: A PET/CT‐guided randomized controlled study

“…Despite these findings, the optimal RIC protocol remained undetermined. The challenge primarily stemmed from the absence of specific molecular or image biomarkers capable of monitoring the biological effects of RIC (Zhao et al., 2023). In our study, we conducted the first investigation into the impact of RIC on cerebral hemodynamics of sICAS patients using PET/CT in conjunction with methazolamide.…”

Remote Ischemic Conditioning to Reduce Perihematoma Edema in Patients with Intracerebral Hemorrhage (RICOCHET): A Randomized Control Trial

“…However, RIC was ineffective in patients with FH and high LDL-C (FMD 3.9 ± 3.0 vs. 1.1 ± 1.5%; p < 0.01) [33]. In addition, statins are also known to blunt the effect of RIC, and this may have further attenuated the effects in the intervention arm [34]. Given the presence of the comorbidities and the strict blood control within the control arm, we may have been unable to detect a difference.…”

Re-evaluation of the cardioprotective effects of cannabinoids against ischemia-reperfusion injury according to the IMproving Preclinical Assessment of Cardioprotective Therapies (IMPACT) criteria

“…Ischemic preconditioning is considered the gold standard of cardioprotection ( Basalay et al, 2020 ). In remote preconditioning, brief episodes of I/R are administered to organs or tissues other than the heart and can be easily applied in a non-invasive way, e.g., using a blood pressure cuff on an arm or a leg ( Lang and Kim, 2022 ; Penna et al, 2022 ; Comità et al, 2023 ; Ferdinandy et al, 2023 ; Zhao et al, 2023 ). Another way to protect the heart against the consequences of I/R injury is pharmacological conditioning (i.e., volatile anesthetics, opioids or α 2 -adrenoceptor agonists), a concept that is based on the administration of specific drugs mimicking the effect of ischemic preconditioning ( Roth et al, 2021 ; Penna et al, 2022 ; Ferdinandy et al, 2023 ).…”