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Remote ischaemic conditioning for stroke: unanswered questions and future directions

Remote ischaemic conditioning (RIC) refers to a process whereby periods of intermittent ischaemia, typically via the cyclical application of a blood pressure cuff to a limb at above systolic pressure, confers systemic protection against ischaemia in spatially distinct vascular territories. The mecha...

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Autores principales: Baig, Sheharyar, Moyle, Bethany, Nair, Krishnan Padmakumari Sivaraman, Redgrave, Jessica, Majid, Arshad, Ali, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258051/
https://www.ncbi.nlm.nih.gov/pubmed/33903181
http://dx.doi.org/10.1136/svn-2020-000722
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author Baig, Sheharyar
Moyle, Bethany
Nair, Krishnan Padmakumari Sivaraman
Redgrave, Jessica
Majid, Arshad
Ali, Ali
author_facet Baig, Sheharyar
Moyle, Bethany
Nair, Krishnan Padmakumari Sivaraman
Redgrave, Jessica
Majid, Arshad
Ali, Ali
author_sort Baig, Sheharyar
collection PubMed
description Remote ischaemic conditioning (RIC) refers to a process whereby periods of intermittent ischaemia, typically via the cyclical application of a blood pressure cuff to a limb at above systolic pressure, confers systemic protection against ischaemia in spatially distinct vascular territories. The mechanisms underlying this have not been characterised fully but have been shown to involve neural, hormonal and systemic inflammatory signalling cascades. Preclinical and early clinical studies have been promising and suggest beneficial effects of RIC in acute ischaemic stroke, symptomatic intracranial stenosis and vascular cognitive impairment. Through systematic searches of several clinical trials databases we identified 48 active clinical trials of RIC in ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage. We summarise the different RIC protocols and outcome measures studied in ongoing clinical trials and highlight which studies are most likely to elucidate the underlying biological mechanisms of RIC and characterise its efficacy in the near future. We discuss the uncertainties of RIC including the optimal frequency and duration of therapy, target patient groups, cost-effectiveness, the confounding impact of medications and the absence of a clinically meaningful biomarker of the conditioning response. With several large clinical trials of RIC expected to report their outcomes within the next 2 years, this review aims to highlight the most important studies and unanswered questions that will need to be addressed before this potentially widely accessible and low-cost intervention can be used in clinical practice.
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spelling pubmed-82580512021-07-16 Remote ischaemic conditioning for stroke: unanswered questions and future directions Baig, Sheharyar Moyle, Bethany Nair, Krishnan Padmakumari Sivaraman Redgrave, Jessica Majid, Arshad Ali, Ali Stroke Vasc Neurol Review Remote ischaemic conditioning (RIC) refers to a process whereby periods of intermittent ischaemia, typically via the cyclical application of a blood pressure cuff to a limb at above systolic pressure, confers systemic protection against ischaemia in spatially distinct vascular territories. The mechanisms underlying this have not been characterised fully but have been shown to involve neural, hormonal and systemic inflammatory signalling cascades. Preclinical and early clinical studies have been promising and suggest beneficial effects of RIC in acute ischaemic stroke, symptomatic intracranial stenosis and vascular cognitive impairment. Through systematic searches of several clinical trials databases we identified 48 active clinical trials of RIC in ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage. We summarise the different RIC protocols and outcome measures studied in ongoing clinical trials and highlight which studies are most likely to elucidate the underlying biological mechanisms of RIC and characterise its efficacy in the near future. We discuss the uncertainties of RIC including the optimal frequency and duration of therapy, target patient groups, cost-effectiveness, the confounding impact of medications and the absence of a clinically meaningful biomarker of the conditioning response. With several large clinical trials of RIC expected to report their outcomes within the next 2 years, this review aims to highlight the most important studies and unanswered questions that will need to be addressed before this potentially widely accessible and low-cost intervention can be used in clinical practice. BMJ Publishing Group 2021-04-26 /pmc/articles/PMC8258051/ /pubmed/33903181 http://dx.doi.org/10.1136/svn-2020-000722 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Baig, Sheharyar
Moyle, Bethany
Nair, Krishnan Padmakumari Sivaraman
Redgrave, Jessica
Majid, Arshad
Ali, Ali
Remote ischaemic conditioning for stroke: unanswered questions and future directions
title Remote ischaemic conditioning for stroke: unanswered questions and future directions
title_full Remote ischaemic conditioning for stroke: unanswered questions and future directions
title_fullStr Remote ischaemic conditioning for stroke: unanswered questions and future directions
title_full_unstemmed Remote ischaemic conditioning for stroke: unanswered questions and future directions
title_short Remote ischaemic conditioning for stroke: unanswered questions and future directions
title_sort remote ischaemic conditioning for stroke: unanswered questions and future directions
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258051/
https://www.ncbi.nlm.nih.gov/pubmed/33903181
http://dx.doi.org/10.1136/svn-2020-000722
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