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

Maedeh  Asadi; Etrat  Hooshmandi; Fatemeh  Emaminia; Hanieh  Mardani; Ali Mohammad  Keshtvarz-Hesamabadi; Mojtaba  Rismanchi; Abbas  Rahimi-Jaberi; Vahid Reza  Ostovan; Nima  Fadakar; Afshin  Borhani-Haghighi

doi:10.18502/cjn.v21i2.10495

Maedeh Asadi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Etrat Hooshmandi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Fatemeh Emaminia Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Hanieh Mardani Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Ali Mohammad Keshtvarz-Hesamabadi Clinical Research Development Center of Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Mojtaba Rismanchi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abbas Rahimi-Jaberi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Vahid Reza Ostovan Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Nima Fadakar Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Afshin Borhani-Haghighi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

DOI: https://doi.org/10.18502/cjn.v21i2.10495

Keywords: Ischemic Preconditioning; Stroke; Carotid Arteries; Stents; Brain Infarction; Angioplasty

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.