Remote ischemic conditioning for acute ischemic stroke part 2: Study protocol for a randomized controlled trial

Ishizuka, Kôzô; Hoshino, Takao; Toi, Sono; Mizuno, Takafumi; Hosoya, Megumi; Saito, Misa; Sato, Yasuto; Yagita, Yoshiki; Todo, Kenichi; Sakaguchi, Manabu; Ohashi, Takashi; Maruyama, Kenji; Hino, Shuji; Honma, Yutaka; Yamagami, Hiroshi; Iguchi, Yasuyuki; Hirano, Teruyuki; Kimura, Kazumi; Kitazono, Takanari; Kitagawa, Kazuo

doi:10.3389/fneur.2022.946431

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…The main endpoint events are safety and incidence of adverse events, and the secondary result is prognosis. A Japanese study is currently underway on the effectiveness of RIC in treating AIS patients within 48 h of symptom onset 36 . The primary outcome will be evaluated by the mRS score 90 days after stroke onset.…”

Section: Clinical Application Of Ric In Strokementioning

confidence: 99%

“…A Japanese study is currently underway on the effectiveness of RIC in treating AIS patients within 48 h of symptom onset. 36 The primary outcome will be evaluated by the mRS score 90 days after stroke onset. In the future, more large‐scale multicenter trials are needed to prove the optimal time window and the most effective application regimen of RIC treatment in patients with AIS, and it is necessary to confirm the brain‐protective effect of RIC treatment in patients with AIS by different metrics such as imaging or blood markers.…”

Section: Clinical Application Of Ric In Strokementioning

confidence: 99%

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Remote ischemic conditioning after stroke: Research progress in clinical study

Jiang,

Wang,

et al. 2023

CNS Neurosci Ther

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Background and PurposeStroke is a leading cause of global morbidity and mortality, indicating the necessity and urgency of effective prevention and treatment. Remote ischemic conditioning (RIC) is a convenient, simple, non‐intrusive, and effective method that can be easily added to the treatment regime of stroke patients. Animal experiments and clinical trials have proved the neuroprotective effects of RIC on brain injury including (examples of neuroprotective effects). This neuroprotection is achieved by raising brain tolerance to ischemia, increasing local cerebral blood perfusion, promoting collateral circulations, neural regeneration, and reducing the incidence of hematomas in brain tissue. This current paper will summarize the studies within the last 2 years for the comprehensive understanding of the use of RIC in the treatment of stroke.MethodsThis paper summarizes the clinical research progress of RIC on stroke (ischemic stroke and hemorrhagic stroke (HS)). This paper is a systematic review of research published on registered clinical trials using RIC in stroke from inception through November 2022. Four major databases (PUBMED, WEB OF SCIENCE, EMBASE, and ClinicalTrials.gov) were searched.ResultsForty‐eight studies were identified meeting our criteria. Of these studies, 14 were in patients with acute ischemic stroke with onset times ranging from 6 h to 14 days, seven were in patients with intravenous thrombolysis or endovascular thrombectomy, 10 were in patients with intracranial atherosclerotic stenosis, six on patients with vascular cognitive impairment, three on patients with moyamoya disease, and eight on patients with HS. Of the 48 studies, 42 were completed and six are ongoing.ConclusionsRIC is safe, feasible, and effective in the treatment of stroke. Large‐scale research is still required to explore the optimal treatment options and mechanisms of RIC in the future to develop a breakthrough in stroke prevention and treatment.

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Section: Clinical Application Of Ric In Strokementioning

confidence: 99%

Section: Clinical Application Of Ric In Strokementioning

confidence: 99%

Remote ischemic conditioning after stroke: Research progress in clinical study

Jiang,

Wang,

et al. 2023

CNS Neurosci Ther

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Comparative Efficacy of Remote Ischemic Conditioning and Hypothermia in Permanent and Transient Cerebral Ischemia in Male Mice

Saito,

Hoshino,

Ishizuka

et al. 2024

J of Neuroscience Research

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Remote ischemic conditioning (RIC) has attracted considerable attention as a brain protection strategy, although its impact remains unclear. Hypothermia is the most effective strategy in experimental transient cerebral ischemia. Therefore, we compared the efficacy of RIC, hypothermia, and no treatment on cerebral ischemia. We assessed the effects of both permanent and transient middle cerebral artery occlusion (MCAO) for 45 min in male mice. Brain hemodynamics were monitored during and after the procedure via 2D color‐coded ultrasound imaging. Ischemic lesions on magnetic resonance imaging (MRI)–diffusion‐weighted imaging (DWI), early breakdown of microtubule‐associated protein 2 (MAP2), expression levels of inflammatory cytokines by reverse transcriptase quantitative polymerase chain reaction (RT‐qPCR), and neurological signs and infarct volume were examined. In permanent MCAO, RIC increased cerebral blood flow (CBF) in the peri‐infarct area, reduced early lesions on MRI–DWI, decreased early MAP2 breakdown, and lowered infarct volume compared with no treatment. However, hypothermia only showed a protective effect against neurological signs. In contrast, in transient MCAO, both RIC and hypothermia reduced the expression of inflammatory cytokines, mitigated MAP2 breakdown, and reduced infarct volume to a similar extent compared with no treatment. In conclusion, although RIC proved to be more effective than hypothermia in permanent MCAO, the protective effects of RIC and hypothermia were comparable in transient cerebral ischemia. Thus, RIC could be a promising strategy for brain protection against cerebral ischemia.

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The potential mechanism and clinical application value of remote ischemic conditioning in stroke

Zhu,

Li,

Lei

et al. 2024

Neural Regeneration Research

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Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/ Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.

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Remote ischemic conditioning for acute ischemic stroke part 2: Study protocol for a randomized controlled trial

Cited by 3 publications

References 40 publications

Remote ischemic conditioning after stroke: Research progress in clinical study

Remote ischemic conditioning after stroke: Research progress in clinical study

Comparative Efficacy of Remote Ischemic Conditioning and Hypothermia in Permanent and Transient Cerebral Ischemia in Male Mice

The potential mechanism and clinical application value of remote ischemic conditioning in stroke

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