Remote Ischemic Post-Conditioning may Improve Post-Stroke Cognitive Impairment: A Pilot Single Center Randomized Controlled Trial

Li, Yuejuan; Liang, Keke; Zhang, Long; Pan, Rui; Hu, Yamei; Zhao, Jianhua

doi:10.1016/j.jstrokecerebrovasdis.2020.105217

Cited by 15 publications

(11 citation statements)

References 16 publications

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“…The RIC-related adverse events (such as redness and skin petechiae on arms) were consistent with those described in previous studies, except for the absence of arm pain. It is possible that participants experienced such pain but did not report it or that participants who had pain were those who withdrew due to RIC intolerance.…”

Section: Discussionsupporting

confidence: 89%

Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke

Chen

Cui

et al. 2022

JAMA

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Question: Does remote ischemic conditioning improve neurological function in patients with acute moderate ischemic stroke? Findings: In this randomized clinical trial that included 1893 participants with acute moderate ischemic stroke, excellent neurological function at 90 days in those randomized to remote ischemic conditioning compared with usual care occurred in 67.4% vs 62.0%, a difference that was statistically significant.Meaning: Although remote ischemic conditioning was associated with better neurological function in patients with acute moderate ischemic stroke, this trial requires replication before concluding efficacy for this intervention.

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Section: Discussionsupporting

confidence: 89%

Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke

Chen

Cui

et al. 2022

JAMA

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“…Small studies have shown the benefits of remote ischemic conditioning for visuospatial, attention, and executive functions 157 and long-term (>6 months) global cognition. 158 Further confirmatory studies with larger samples are warranted. 159 Several studies suggest potential benefit from transcranial magnetic stimulation and transcranial direct current stimulation (tDCS).…”

Section: Emerging Complementary and Integrative Treatmentsmentioning

confidence: 97%

Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association/American Stroke Association

Husseini¹,

Katzan²,

Rost³

et al. 2023

Stroke

110

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Purpose: Cognitive impairment is a common consequence of stroke and has direct implications for poststroke functioning and quality of life, including the ability to maintain a job, live independently, sustain interpersonal relationships, and drive a vehicle. In this scientific statement, we critically appraise the literature on the prevalence, diagnosis, and management of poststroke cognitive impairment (PSCI) and provide a framework for clinical care while highlighting gaps that merit further study. Methods: We performed a scoping literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, clinical guidelines, review articles, and editorials on the incidence and prevalence, natural history, diagnosis, and management of PSCI. Scoping reviews determine the scope of a body of literature on a given topic to indicate the volume of literature and the studies currently available and provide an overview of its focus. Results: PSCI is common after stroke, especially in the first year, and ranges from mild to severe. Although cognitive impairment is reversible in some cases early after stroke, up to one-third of individuals with stroke develop dementia within 5 years. The pathophysiology is not yet fully elucidated but is likely attributable to an acute stroke precipitating a series of pathological events, often in the setting of preexisting microvascular and neurodegenerative changes. Screening for associated comorbidities and interdisciplinary management are integral components of the care of individuals with PSCI. There is a need for prospective studies evaluating the individual trajectory of PSCI and the role of the acute vascular event in the predisposition for Alzheimer disease and related dementias, as well as high-quality, randomized clinical trials focused on PSCI management.

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“…A study demonstrated the safety and efficacy of RIC in patients with AIS within 72 h of onset and suggested that RIC may improve neurological recovery through a protective mechanism of increasing cerebral blood flow to improve cerebral perfusion 32 . All enrolled patients were randomly divided into RIC group (20 mmHg above systolic BP) and a control group (cuff inflation to 30 mmHg) and treated with I/R (5 min of pressure and 5 min of relaxation with a blood pressure cuff on the nonparalyzed arm) once a day for 14 consecutive days.…”

Section: Clinical Application Of Ric In Strokementioning

confidence: 99%

“…The results show that compared with the control group and conventional drug therapy, RIC is effective and safe in the treatment of AIS and can alleviate neurological deficits in AIS patients. RIC does not affect the platelet function of patients and can be used as adjuvant therapy for combined antiplatelet therapy in AIS patients.Abbreviations: ADAS-Cog, Alzheimer's disease assessment scale-cognitive section; ADL, activities of daily living; APTT, activated partial prothrombin time; bFGF, basic fibroblast growth factor; BI, measure of independence in activities of daily living; DHI, dizziness handicap inventory; EQ-5D, Quality of Life Assessment Questionnaire; ET-1, endothelin-1; GCS, Glasgow Coma Scale; GOSE, Glasgow Outcome Score Extended; HAMD, Hamilton Depression Scale; HRV, heart rate variability; hs-CRP, high-sensitivity c-reactive protein; HT, hemorrhagic transformation; ICAM-1, intercellular adhesion molecule-1; Lis, lacunar in-fractions; MACE, major adverse cardiovascular events; MFV, mean flow velocity; MMP9, matrix metalloprotein-9; MoCA, minimum obstruction clearance altitude; mRS, Modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; OH1, heme oxygenase-1; PGIC, patient global impression of change; PHE, perihematomal edema; PSV, peak systolic velocity; PT, prothrombin time; PTA, prothrombin activity; rCBF, regional cerebral blood flow; rMTT, relative mean transit time; SAP, serum amyloid protein; ScO2, cerebral oxygen saturation; sICH, symptomatic hemorrhagic transformation; TOI, tissue oxygenation index; VAS, Visual Analog Pain Scale; VEGF, vascular endothelial growth factor; WMLs, white matter lesions.A study demonstrated the safety and efficacy of RIC in patients with AIS within 72 h of onset and suggested that RIC may improve neurological recovery through a protective mechanism of increasing cerebral blood flow to improve cerebral perfusion 32. All enrolled patients were randomly divided into RIC group (20 mmHg above systolic BP) and a control group (cuff inflation to 30 mmHg) and treated with I/R scores, regional relative mean transit time (p < 0.05), increased cure rate of mRS, regional relative cerebral blood flow (p < 0.05), and reduced cerebral ischemic volume by 31.3% (p < 0.05).…”

mentioning

confidence: 99%

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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Remote Ischemic Post-Conditioning may Improve Post-Stroke Cognitive Impairment: A Pilot Single Center Randomized Controlled Trial

Cited by 15 publications

References 16 publications

Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke

Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke

Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association/American Stroke Association

Remote ischemic conditioning after stroke: Research progress in clinical study

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