Therapeutic Potential of Remote Ischemic Conditioning in Vascular Cognitive Impairment

Xu, Rui; He, Qianyan; Wang, Yan; Yang, Yi; Guo, Zhen‐Ni

doi:10.3389/fncel.2021.706759

Cited by 6 publications

(3 citation statements)

References 188 publications

(199 reference statements)

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“…14,15 The protective mechanisms may involve reduced inflammatory responses, enhanced recovery, and angioneogenesis. 1,[16][17][18][19][20] Another study found beneficial effects on administrating isosorbide mononitrate in patients with SVD. 21 Interestingly, nitric oxide release is one of the proposed mechanisms of RIC and may explain some of the observed differences.…”

Section: Discussionmentioning

confidence: 99%

Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial

Blauenfeldt,

Mortensen,

Hjort

et al. 2024

Stroke

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BACKGROUND: Remote ischemic conditioning (RIC) is a simple and noninvasive procedure that has proved to be safe and feasible in numerous smaller clinical trials. Mixed results have been found in recent large randomized controlled trials. This is a post hoc subgroup analysis of the RESIST trial (Remote Ischemic Conditioning in Patients With Acute Stroke), investigating the effect of RIC in different acute ischemic stroke etiologies, and whether an effect was modified by treatment adherence. METHODS: Eligible patients were adults (aged ≥18 years), independent in activities of daily living, who had prehospital stroke symptoms with a duration of less than 4 hours. They were randomized to RIC or sham. The RIC treatment protocol consisted of 5 cycles with 5 minutes of cuff inflation alternating with 5 minutes with a deflated cuff. Acceptable treatment adherence was defined as when at least 80% of planned RIC cycles were received. The analysis was performed using the entire range (shift analysis) of the modified Rankin Scale (ordinal logistic regression). RESULTS: A total of 698 had acute ischemic stroke, 253 (36%) were women, and the median (interquartile range) age was 73 (63–80) years. Median (interquartile range) overall adherence to RIC/sham was 91% (68%–100%). In patients with a stroke due to cerebral small vessel disease, who were adherent to treatment, RIC was associated with improved functional outcome, and the odds ratio for a shift to a lower score on the modified Rankin Scale was 2.54 (1.03–6.25); P =0.042. The association remained significant after adjusting for potential confounders. No significant associations were found with other stroke etiologies, and the overall test for interaction was not statistically significant (χ 2 , 4.33, P =0.23). CONCLUSIONS: In patients with acute ischemic stroke due to cerebral small vessel disease, who maintained good treatment adherence, RIC was associated with improved functional outcomes at 90 days. These results should only serve as a hypothesis-generating for future trials. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03481777.

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Section: Discussionmentioning

confidence: 99%

Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial

Blauenfeldt,

Mortensen,

Hjort

et al. 2024

Stroke

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“…This increase in cerebral blood flow (CBF) is critical for ensuring adequate cerebral supply after acute or chronic CBF reduction and preventing cognitive deterioration. [ 26 ]…”

Section: Discussionmentioning

confidence: 99%

Remote ischemic preconditioning and cognitive dysfunction following coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

Siburian,

Fadillah,

Altobaishat

et al. 2024

Saudi Journal of Anaesthesia

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Introduction: Postoperative cognitive dysfunction (POCD) is a common neurological issue following cardiopulmonary bypass (CPB)-assisted heart surgery. Remote ischemic preconditioning (RIPC) increases the tolerance of vital organs to ischemia/reperfusion injury, leading to reduced brain injury biomarkers and improved cognitive control. However, the exact mechanisms underlying RIPC’s neuroprotective effects remain unclear. This systematic review aimed to explore the hypothesis that RIPC lowers neurocognitive dysfunction in patients undergoing CPB surgery. Method: All relevant studies were searched in PubMed, ScienceDirect, EBSCOhost, Google Scholar, Semantic Scholar, Scopus, and Cochrane Library database. Assessment of study quality was carried out by two independent reviewers individually using the Cochrane Risk of Bias (RoB-2) tool. Meta-analysis was performed using a fixed-effect model due to low heterogeneity among studies, except for those with substantial heterogeneity. Results: A total of five studies with 1,843 participants were included in the meta-analysis. RIPC was not associated with reduced incidence of postoperative cognitive dysfunction (five RCTs, odds ratio [OR: ] 0.79, 95% confidence interval [CI]: 0.56–1.11) nor its improvement (three RCTs, OR: 0.80, 95% CI: 0.50–1.27). In addition, the analysis of the effect of RIPC on specific cognitive function tests found that pooled SMD for RAVLT 1-3 and RAVLT LT were −0.07 (95% CI: −0.25,012) and −0.04 (95% CI: −0.25–0.12), respectively, and for VFT semantic and phonetic were −0.15 (95% CI: −0.33–0.04) and 0.11 (95% CI: −0.40–0.62), respectively. Conclusion: The effect of RIPC on cognitive performance in CABG patients remained insignificant. Results from previous studies were unable to justify the use of RIPC as a neuroprotective agent in CABG patients.

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“…Although it is technically difficult to assess the effect of RIC on brain microcirculation, there is evidence that multiple RIC applications improve cerebral blood flow [60] and enhance dynamic cerebral autoregulation in healthy individuals [61], which requires further study of its effects on brain vasculature and endothelial remodeling. Nevertheless, it is already evident that RIC in pre-and postconditioning modes is protective against brain cerebrovascular cognitive dysfunction [62]. The possible molecular mechanisms of RIC effects on endothelial and neuronal cells will be discussed in subsequent chapters.…”

Section: Ric and Neuroimmunohumoral Pathwaymentioning

confidence: 99%

Neuroadaptive Biochemical Mechanisms of Remote Ischemic Conditioning

Baranova,

Nalivaeva,

Rybnikova

2023

IJMS

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This review summarizes the currently known biochemical neuroadaptive mechanisms of remote ischemic conditioning. In particular, it focuses on the significance of the pro-adaptive effects of remote ischemic conditioning which allow for the prevention of the neurological and cognitive impairments associated with hippocampal dysregulation after brain damage. The neuroimmunohumoral pathway transmitting a conditioning stimulus, as well as the molecular basis of the early and delayed phases of neuroprotection, including anti-apoptotic, anti-oxidant, and anti-inflammatory components, are also outlined. Based on the close interplay between the effects of ischemia, especially those mediated by interaction of hypoxia-inducible factors (HIFs) and steroid hormones, the involvement of the hypothalamic–pituitary–adrenocortical system in remote ischemic conditioning is also discussed.

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Therapeutic Potential of Remote Ischemic Conditioning in Vascular Cognitive Impairment

Cited by 6 publications

References 188 publications

Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial

Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial

Remote ischemic preconditioning and cognitive dysfunction following coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

Neuroadaptive Biochemical Mechanisms of Remote Ischemic Conditioning

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