Document Type : Original Article
Authors
- Maedeh Asadi 1
- Etrat Hooshmandi 1
- Fatemeh Emaminia 1
- Hanieh Mardani 1
- Ali Mohammad Keshtvarz-Hesamabadi 2
- Mojtaba Rismanchi 1
- Abbas Rahimi-Jaberi 1
- Vahid Reza Ostovan 1
- Nima Fadakar 1
- Afshin Borhani-Haghighi 1
1 Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Clinical Research Development Center of Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Remote ischemic preconditioning (RIPC) has been proposed as a possible potential treatment for ischemic stroke. This study aimed to investigate the frequency of micro-embolic brain infarcts after RIPC in patients with stroke who underwent elective carotid artery stenting (CAS) treatment.
Methods: This study was managed at Shiraz University of Medical Sciences in southwest Iran. Patients undergoing CAS were randomly allocated into RIPC and control groups. Patients in the RIPC group received three intermittent cycles of 5-minute arm ischemia followed by reperfusion using manual blood cuff inflation/deflation less than 30 minutes before CAS treatment. Afterward, stenting surgery was conducted. Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), was acquired within the first 24 hours after CAS.
Results: Seventy-four patients were recruited (79.7% men, age: 72.30 ± 8.57). Both groups of RIPC and control
had no significant difference in baseline parameters (P > 0.05). Fifteen patients (40.5%) in the RIPC group and 19 (54.1%) patients in the control group developed restricted lesions in DWI MRI. In DWI+ patients, there were no significant differences according to the number of lesions, lesion surface area, largest lesion diameter, cortical infarcts percent, and ipsilateral and bilateral infarcts between the two groups.
Conclusion: Although RIPC is a safe and non-invasive modality before CAS to decrease infarcts, this study did not show the advantage of RIPC in the prevention of infarcts following CAS. It may be because of the small sample size.
Keywords
- Borhani-Haghighi A, Safari R, Heydari ST, Soleimani F, Sharifian M, Yektaparast KS, et al. Hospital mortality associated with stroke in southern iran. Iran J Med Sci 2013; 38(4): 314-20.
- Borhani-Haghighi A, Emami M, Vasaksi AS, Shariat A, Banihashemi MA, Nikseresht A, et al. Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors. J Vasc Interv Neurol 2015; 8(1): 11-6.
- Borhani HA, Yousefi S, Bahramali E, Kokabi S, Heydari ST, Shariat A, et al. Demographic and technical risk factors of 30-day stroke, myocardial infarction, and/or death in standard- and high-risk patients who underwent carotid angioplasty and stenting. Interv Neurol 2015; 3(3-4): 165-73.
- Borhani HA, Kokabi S, Yousefi S, Emami M, Shariat A, Nikseresht A, et al. The prevalence and factors contributing to hemodynamic depression in patients undergoing carotid angioplasty and stenting. J Vasc Interv Neurol 2015; 8(4): 5-10.
- Bendszus M, Stoll G. Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 2006; 5(4): 364-72.
- Maggio P, Altamura C, Landi D, Migliore S, Lupoi D, Moffa F, et al. Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment. J Neurol Sci 2013; 328(1-2): 58-63.
- Bagheri S, Shahbazi S, Shafa M, Borhani-Haghighi A, Kiani M, Sagheb MM. The effect of remote ischemic preconditioning on the incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Iran J Med Sci 2018; 43(6): 587-95.
- Zhao W, Meng R, Ma C, Hou B, Jiao L, Zhu F, et al. Safety and efficacy of remote ischemic preconditioning in patients with severe carotid artery stenosis before carotid artery stenting: A proof-of-concept, randomized controlled trial. Circulation 2017; 135(14): 1325-35.
- Hougaard KD, Hjort N, Zeidler D, Sorensen L, Norgaard A, Hansen TM, et al. Remote ischemic perconditioning as an adjunct therapy to thrombolysis in patients with acute ischemic stroke: A randomized trial. Stroke 2014; 45(1): 159-67.
- Heusch G, Botker HE, Przyklenk K, Redington A, Yellon D. Remote ischemic conditioning. J Am Coll Cardiol 2015; 65(2): 177-95.
- Chen G, Thakkar M, Robinson C, Dore S. Limb remote ischemic conditioning: mechanisms, anesthetics, and the potential for expanding therapeutic options. Front Neurol 2018; 9: 40.
- Zhang C. The role of inflammatory cytokines in endothelial dysfunction. Basic Res Cardiol 2008; 103(5): 398-406.
- Rismanchi M, Borhani-Haghighi A. Comparison of clinical and radiological outcome of carotid angioplasty and stenting after direct navigation versus exchange methods: A randomized clinical trial. J Vasc Interv Neurol 2017; 9(6): 45-50.
- Meng R, Ding Y, Asmaro K, Brogan D, Meng L, Sui M, et al. Ischemic conditioning is safe and effective for Octo- and nonagenarians in stroke prevention and treatment. Neurotherapeutics 2015; 12(3): 667-77.
- Healy DA, Boyle E, McCartan D, Bourke M, Medani M, Ferguson J, et al. A multicenter pilot randomized controlled trial of remote ischemic preconditioning in major vascular surgery. Vasc Endovascular Surg 2015; 49(8): 220-7.
- Wang Y, Reis C, Applegate R, Stier G, Martin R, Zhang JH. Ischemic conditioning-induced endogenous brain protection: Applications pre-, per- or post-stroke. Exp Neurol 2015; 272: 26-40.
- Davies WR, Brown AJ, Watson W, McCormick LM, West NE, Dutka DP, et al. Remote ischemic preconditioning improves outcome at 6 years after elective percutaneous coronary intervention: The CRISP stent trial long-term follow-up. Circ Cardiovasc Interv 2013; 6(3): 246-51.
- Skyschally A, van Caster P, Iliodromitis EK, Schulz R, Kremastinos DT, Heusch G. Ischemic postconditioning: Experimental models and protocol algorithms. Basic Res Cardiol 2009; 104(5): 469-83.
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