Remote Ischemic Conditioning as a new treatment for ischemic stroke

20 June 2019

In Stroke Thijs Landman and colleagues described the clinical and preclinical evidence for a new non-invasive treatment in patients with an ischemic stroke: Remote Ischemic Conditioning. Remote ischemic conditioning consists of inducing short bouts of ischemia and reperfusion to a limb (using a regular blood pressure cuff) which subsequently protects remote organs against prolonged ischemia. This review summarizes the current evidence for this new treatment in ischemic stroke.

Acute ischemic stroke (AIS) is the leading cause of disability in adults worldwide and has the second highest mortality of all cardiovascular diseases.1 The burden of stroke is likely to increase significantly during the next decades, primarily because of population growth and aging.2 Given the detrimental impact of stroke on health care (costs) and patient well being, it is imperative to explore opportunities for novel therapies to add to the current treatment to further minimize neurologic injury. During an ischemic stroke, occlusion of a cerebral artery abrogates cerebral perfusion, causing brain tissue distal from the occlusion to become deprived of oxygen and nutrients, ultimately leading to ischemic injury. Surrounding the ischemic core, an area called the penumbra contains potentially reversible injured brain tissue, which may remain viable for several hours. While the time window to attenuate the detrimental impact of an ischemic stroke seems limited to 6 hours after onset of AIS,3,4 recent research suggests that subgroups may benefit ≤24 hours.5,6 This time window of 6 to 24 hours offers perspective for hospital-based, additional therapies to reduce ischemic injury and minimize clinical deterioration in patients with AIS. This review focuses on remote ischemic conditioning (RIC) as an additive therapy to improve clinical outcomes in patients with AIS, both when applied as single and repeated bouts. RIC refers to the application of several cycles of brief ischemia and reperfusion (I/R) to a limb (using a blood pressure cuff). Preclinical work revealed this stimulus to reduce neural damage after reperfusion,7–11 validating the concept that RIC may have clinical potential in AIS. RIC, therefore, represents a simple, low-cost therapeutic strategy that may salvage brain tissue in the penumbral area. In this review, we will summarize (pre)clinical evidence for the efficacy of RIC as an additional therapy in patients with AIS.

Publication
Remote Ischemic Conditioning as an Additional Treatment for Acute Ischemic Stroke
Landman TRJ, Schoon Y, Warlé MC, de Leeuw FE, Thijssen DHJ.

Thijs Landman is member of theme Vascular damage.