Safety and efficacy of remote ischemic conditioning in pediatric moyamoya disease patients treated with revascularization therapy

Sijie Li; Wenbo Zhao; Cong Han; Gary B Rajah; Changhong Ren; Jiali Xu; Shuling Shang; Ran Meng; Yuchuan Ding; Xunming Ji

doi:10.4103/bc.bc_30_17

Safety and efficacy of remote ischemic conditioning in pediatric moyamoya disease patients treated with revascularization therapy

Brain Circ. 2017 Oct-Dec;3(4):213-218. doi: 10.4103/bc.bc_30_17. Epub 2017 Dec 29.

Authors

Sijie Li^{1

2}, Wenbo Zhao^{1

3}, Cong Han⁴, Gary B Rajah⁵, Changhong Ren^{1

2}, Jiali Xu^{1

3}, Shuling Shang^{1

3}, Ran Meng³, Yuchuan Ding⁵, Xunming Ji^{1

6}

Affiliations

¹ Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
² Beijing Municipal Geriatric Medical Research Center, Beijing, China.
³ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁴ Department of Neurosurgery, 307 Hospital of PLA, Beijing, China.
⁵ Department of Neurosurgery, Wayne State University, Detroit, MI, USA.
⁶ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.

Abstract

Background: Revascularization surgery has been the standard treatment to prevent ischemic stroke in pediatric Moyamoya disease (MMD) patients with ischemic symptoms. However, perioperative complications, such as hyperperfusion syndrome, new infarct on imaging, or ischemic stroke, are inevitable. Remote ischemic conditioning (RIC) is a noninvasive and easy-to-use neuroprotective strategy, and it has potential effects on preventing hyperperfusion syndrome and ischemic infarction.

Aims: The aim of this study is to investigate the safety and efficacy of RIC in pediatric MMD patients undergoing revascularization surgery.

Method: A total of 60 pediatric MMD patients with one or more ischemic symptoms will be recruited and allocated in 1:1 ratio to the RIC group and sham group, respectively. Both RIC and sham RIC will be performed twice daily for 7 consecutive days before revascularization surgery with different cuff pressures during the ischemia period (50 mmHg over-systolic blood pressure and 30 mmHg). Single photon emission computed tomography will be performed within 7 days preoperatively and 3 months postoperatively, respectively, to evaluate the cerebral perfusion status. Other outcomes, including safety, plasma biomarker, functional outcome, and the incidence of infarction and its size, will also be evaluated.

Conclusion: This study will provide insights into the preliminary proof of principle, safety, and efficacy of RIC in pediatric MMD patients undergoing revascularization surgery therapy, and this data will provide parameters for future larger scale clinical trials if efficacious.

Keywords: Pediatric moyamoya disease; remote ischemic conditioning; revascularization therapy.