But what about these lower limb interventions? Does your doctor know of them?
Leg compressions may enhance stroke recovery August 2012
Leg wraps raise hopes of saved lives after strokes May 2013
Your doctor and hospital not knowing and implementing these easy interventions is the very pinnacle of incompetence.
Lower Limb Ischaemic Per-Conditioning Does Not Reduce Final Infarct Size in Patients With Acute Ischemic Stroke
MILAN,
Italy -- May 24, 2019 -- In-hospital remote ischaemic per-conditioning
(per-CID) within 6 hours is safe, but shows no benefits over sham
procedure for patients with confirmed acute ischaemic stroke undergoing
thrombolysis, according to a study presented here at the 5th European
Stroke Organisation Conference (ESOC).
The findings, presented by Fernando Pico, MD, Versailles Mignot Hospital, Versailles, France, come from the Remote Ischemic Conditioning in Acute Brain Infarction Study (RESCUE-BRAIN) trial.
per-CID was designed to cause transient limb ischaemia to induce ischaemic tolerance and promote endogenous mechanisms to increase cerebral blood flow. per-CID showed a cardioprotective effect in a randomised control trial involving 250 patients within the 6 first hours of myocardial infarction who were candidates for primary angioplasty.
“In cardiology, for myocardial infarction, one study showed that ischaemic conditioning reduces the size of the myocardial lesion,” said Dr. Pico.
Therefore, the researchers wanted to determine whether per-CID in the unaffected lower limb performed within the first 6 hours of cerebral infarction could reduce the growth of the brain infarction.
For the current study, 93 patients with MRI-confirmed carotid ischaemic stroke received a lower limb tourniquet on half of the thigh within 6 hours of symptom onset. The per-conditioning protocol consists of 4 cycles of electronic tourniquet inflation (5 minutes) and deflation (5 minutes) to the thigh over 40 minutes. Another 95 patients had a sham cuff placed. MRI was repeated 24 hours after stroke onset.
Around 90% of patients had been treated with intravenous thrombolysis (median time, 2.5 hours) and about a third had undergone endovascular treatment (median time, 3.2 hours). Median time between stroke onset and cuff inflation was 3.7 hours.
The primary outcome was changes in diffusion-weighted imaging brain infarction volume between baseline and 24 hours.
In the intention-to-treat analysis, there were no significant differences between groups in final infarct size (mean log10 change, 0.37 vs 0.30 and median percentage change in brain infarction volume, 34.1% vs 36.5%).
Similarly, there were no significant differences for secondary endpoints of change in NIHSS score at 24 hours, 90-day Bathel ≥95, and 90-day modified Rankin score 0-1.
“RESCUE BRAIN is a neutral randomised controlled trial, with no benefit, but not harmful,” said Dr. Pico.
[Presentation title: A French Multicenter Randomized Trial on Neuroprotection With Lower Limb Ischemic Per-Conditioning in the Acute Phase of Cerebral Infarction]
The findings, presented by Fernando Pico, MD, Versailles Mignot Hospital, Versailles, France, come from the Remote Ischemic Conditioning in Acute Brain Infarction Study (RESCUE-BRAIN) trial.
per-CID was designed to cause transient limb ischaemia to induce ischaemic tolerance and promote endogenous mechanisms to increase cerebral blood flow. per-CID showed a cardioprotective effect in a randomised control trial involving 250 patients within the 6 first hours of myocardial infarction who were candidates for primary angioplasty.
“In cardiology, for myocardial infarction, one study showed that ischaemic conditioning reduces the size of the myocardial lesion,” said Dr. Pico.
Therefore, the researchers wanted to determine whether per-CID in the unaffected lower limb performed within the first 6 hours of cerebral infarction could reduce the growth of the brain infarction.
For the current study, 93 patients with MRI-confirmed carotid ischaemic stroke received a lower limb tourniquet on half of the thigh within 6 hours of symptom onset. The per-conditioning protocol consists of 4 cycles of electronic tourniquet inflation (5 minutes) and deflation (5 minutes) to the thigh over 40 minutes. Another 95 patients had a sham cuff placed. MRI was repeated 24 hours after stroke onset.
Around 90% of patients had been treated with intravenous thrombolysis (median time, 2.5 hours) and about a third had undergone endovascular treatment (median time, 3.2 hours). Median time between stroke onset and cuff inflation was 3.7 hours.
The primary outcome was changes in diffusion-weighted imaging brain infarction volume between baseline and 24 hours.
In the intention-to-treat analysis, there were no significant differences between groups in final infarct size (mean log10 change, 0.37 vs 0.30 and median percentage change in brain infarction volume, 34.1% vs 36.5%).
Similarly, there were no significant differences for secondary endpoints of change in NIHSS score at 24 hours, 90-day Bathel ≥95, and 90-day modified Rankin score 0-1.
“RESCUE BRAIN is a neutral randomised controlled trial, with no benefit, but not harmful,” said Dr. Pico.
[Presentation title: A French Multicenter Randomized Trial on Neuroprotection With Lower Limb Ischemic Per-Conditioning in the Acute Phase of Cerebral Infarction]
No comments:
Post a Comment