The effect of repeated remote ischemic postconditioning after an ischemic stroke (REPOST): A randomized controlled trial

  Has your hospital implemented remote ischemic conditioning yet? WHAT THE FUCK ARE THEY WAITING FOR? These earlier pieces suggested it helps, why didn't yours turn out that way?

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The effect of repeated remote ischemic postconditioning after an ischemic stroke (REPOST): A randomized controlled trial

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Thijs RJ Landman, Yvonne Schoon, Michiel C Warlé, ...

First Published June 14, 2022 Research Article Find in PubMed 

https://doi.org/10.1177/17474930221104710

Article information

Abstract

Background and Aims:

A potential strategy to treat ischemic stroke may be the application of repeated remote ischemic postconditioning (rIPostC). This consists of several cycles of brief periods of limb ischemia followed by reperfusion, which can be applied by inflating a simple blood pressure cuff and subsequently could result in neuroprotection after stroke.

Methods:

Adult patients admitted with an ischemic stroke in the past 24 h were randomized 1:1 to repeated rIPostC or sham-conditioning. Repeated rIPostC was performed by inflating a blood pressure cuff around the upper arm (4 × 5 min at 200 mm Hg), which was repeated twice daily during hospitalization with a maximum of 4 days. Primary outcome was infarct size after 4 days or at discharge. Secondary outcomes included the modified Rankin Scale (mRS)-score after 12 weeks and the National Institutes of Health Stroke Scale (NIHSS) at discharge.

Results:

The trial was preliminarily stopped after we included 88 of the scheduled 180 patients (average age: 70 years, 68% male) into rIPostC (n = 40) and sham-conditioning (n = 48). Median infarct volume was 2.19 mL in rIPostC group and 5.90 mL in sham-conditioning, which was not significantly different between the two groups (median difference: 3.71; 95% CI: −0.56 to 6.09; p = 0.31). We found no significant shift in the mRS score distribution between groups. The adjusted common odds ratio was 2.09 (95% CI: 0.88–5.00). We found no significant difference in the NIHSS score between groups (median difference: 1.00; 95% CI: −0.99 to 1.40; p = 0.51).

Conclusion:

This study found no significant improvement in infarct size or clinical outcome in patients with an acute ischemic stroke who were treated with repeated remote ischemic postconditioning. However, due to a lower-than-expected inclusion rate, no definitive conclusions about the effectiveness of rIPostC can be drawn

Keywords

Acute stroke therapy, MRI, neuroprotection, treatment, ischemic stroke, therapy

Introduction

A potential new(2012 or 2013 is new?) strategy to treat acute ischemic stroke may be the application of remote ischemic postconditioning (rIPostC). This refers to an intervention where an ischemic stimulus is applied distant from the brain (e.g. a limb) within hours after an ischemic stroke, potentially resulting in neuroprotection.¹ rIPostC consists of several cycles of brief periods of limb ischemia followed by reperfusion, which can be applied by inflating a simple blood pressure cuff.^2–4 The presumed neuroprotective effects of rIPostC are hypothesized to be related to a reduction of ischemia reperfusion injury in the brain after the ischemic stroke and are supposedly most prominent when rIPostC is started as soon as possible after the onset of symptoms.^5,6 Several studies support the ability of rIPostC to reduce neural damage after reperfusion.^7,8 Moreover, it has been postulated that, in addition to the short-lasting benefits of a single bout of rIPostC, longer-lasting benefits may be induced with repeated conditioning,¹ which has been confirmed in several preclinical studies.⁹ The use of repeated rIPostC may be a simple strategy to minimize the clinical impact of ischemic stroke. Importantly, rIPostC is virtually cost-free, non-pharmacological, non-invasive and without any known adverse effects. This study examined whether adding repeated rIPostC to the current treatment of stroke patients has beneficial effects on infarct size and clinical outcome.