Remote ischemic conditioning for the treatment of ischemic moyamoya disease

Abstract

Aims This study investigated the safety and efficacy of remote ischemic conditioning (RIC) on ameliorating the sequelae of ischemic moyamoya disease (iMMD). Methods A total of 30 iMMD patients underwent long‐term RIC and were followed up at 0.5, 1, and 2 years for clinical outcomes, including frequency of stroke recurrence, Patient Global Impression of Change (PGIC) scale, peak systolic velocities (PSV), and cerebral perfusion. Results During the whole RIC treatment process, no RIC‐related adverse event occurred. Only one of 30 patients suffered a onetime infarction (3.3%), and the ratios of acceptable PGIC were 88.2%, 64.3%, and 92.3% at 0.5, 1, and 2 years follow‐up. Kaplan‐Meier analysis showed the frequency of stroke recurrence was significantly reduced after RIC (P = .013). The frequency of TIA per week was 1.1 (0.6, 2.8) prior to RIC and 0.1 (0.0, 0.5) post‐RIC (P < .01). Compared to baseline, PSV values were significantly reduced after RIC treatment (P = .002 at 0.5, P = .331 at 1, and P = .006 at 2 years). In patients undergoing perfusion studies, 75% obtained improvement on followed‐up SPECT and 95% on followed‐up PET maps. Conclusions Remote ischemic conditioning may be beneficial on controlling iMMD‐induced ischemic events, relieving symptoms, and improving cerebral perfusion, without incidence of complications in this case series.

Daily Remote Ischemic Conditioning Can Improve Cerebral Perfusion and Slow Arterial Progression of Adult Moyamoya Disease—A Randomized Controlled Study

“…RIC has been shown to improve CBF of patients with chronic circulation insufficiency like ICAS by promoting angiogenesis or arteriogenesis ( 9 – 11 , 30 , 31 ). A recent single-arm study also observed an improvement of cerebral perfusion in patients with MMD by RIC treatment ( 14 ). This study showed that mCBF of the MCA region was improved in the RIC group.…”

“…Wang et al reported that daily RIC for 1 year could improve cognitive function and reduce the volume of white matter hyperintensities of small vessel disease ( 13 ). Recently, a single-arm study has reported that RIC relieved ischemic events and improved perfusion in ischemic patients with MMD ( 14 ). However, the efficacy of RIC for patients with MMD is still unknown in a randomized controlled setting.…”

Therapeutic Potential of Remote Ischemic Conditioning in Vascular Cognitive Impairment

“…To this end, repetitive daily RIC, termed chronic RIC, has gained much attention. It is able to confer a continuous and long-lasting effect, and thus, is more beneficial for the treatment of chronic diseases ( Ding J. Y. et al, 2020 ). Although many studies on RIC have been carried out, the underlying mechanism still needs to be elucidated.…”

“…It has been reported that a single RIC treatment in preclinical studies significantly enhanced regional CBF after acute ischemic stroke ( Hoda et al, 2012 , 2014 ). Meanwhile, repeated daily RIC is efficient in improving global CBF in chronic ischemia conditions, such as sICAS and Moyamoya disease (MMD) ( Meng et al, 2012 ; Ding J. Y. et al, 2020 ).…”

Chronic remote ischemic conditioning for symptomatic internal carotid or middle cerebral artery occlusion: A prospective cohort study

“…12,25 However, these studies mainly included patients with cerebrovascular stenosis, and the follow-up period for most patients was less than 2 years. To the best of our knowledge, this study is the first to reveal the potential effects of RIC in pa-…”