Remote ischemic conditioning for stroke: clinical data, challenges, and future directions

Ann Clin Transl Neurol. 2018 Nov 15;6(1):186-196. doi: 10.1002/acn3.691. eCollection 2019 Jan.

Abstract

Despite great improvement during the past several decades, the management of stroke is still far from satisfactory, which warrants alternative or adjunctive strategies. Remote ischemic conditioning (RIC), an easy-to-use and noninvasive therapy, can be performed in various clinical scenarios (e.g., prehospital transportation, intrahospital, and at home), and it has been widely investigated for stroke management. RIC has been demonstrated to be well tolerated in patients with acute ischemic stroke and aneurysm subarachnoid hemorrhage, and it may benefit these patients by improving clinical outcomes; in patients with intracranial atherosclerosis, long-term repeated RIC could be safely performed and benefit patients by reducing recurrent ischemic stroke and transient ischemic attack, as well as improving cerebral perfusion status; long-term repeated RIC may also benefit patients with cerebral small vessel disease by slowing cognitive decline and reducing volume of white matter hyperintensities on brain MRI; in patients with severe carotid atherosclerotic stenosis undergoing stenting, preprocedural RIC could reduce the odds of new brain lesions on postprocedural MRI. Previous clinical studies suggest broad future prospects of RIC in the field of cerebrovascular diseases. However, the optimal RIC protocol and the mechanisms that RIC protects the brain is not fully clear, and there is lack of sensitive and specific biomarkers of RIC, all these dilemmas prevent RIC from entering clinical practice. This review focuses on recent advances in clinical studies of RIC in stroke management, its challenges, and the potential directions of future studies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain / blood supply
  • Brain / pathology
  • Brain Ischemia / prevention & control*
  • Cerebral Small Vessel Diseases / prevention & control
  • Humans
  • Intracranial Arteriosclerosis / prevention & control
  • Ischemic Preconditioning / methods*
  • Stents
  • Stroke / prevention & control*
  • Subarachnoid Hemorrhage / prevention & control
  • Treatment Outcome

Grants and funding

This work was funded by National Key R&D Program of China grant 2017YFC1308405; Chang Jiang Scholars Program grant T2014251; Capital Health Research and Development of Special grant 2016‐4‐1032.