Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, October 11, 2023

Remote ischemic conditioning for acute stroke

Ask your doctor if this definitively refutes all the earlier research suggesting that it worked? Your doctor needs to know the answer prior to treating you. Does s/he?

But the modified Rankin score has no objectivity and can't tell slight increases in functionality. So I consider anyone using it to not know what they are doing.

mRS scale:

0  The patient has no residual symptoms.

1  The patient has no significant disability; able to carry out all pre-stroke activities.

2  The patient has slight disability; unable to carry out all pre-stroke activities but able to look after self without daily help.

3  The patient has moderate disability; requiring some external help but able to walk without the assistance of another individual.

4  The patient has moderately severe disability; unable to walk or attend to bodily functions without assistance of another individual.

5  The patient has severe disability; bedridden, incontinent, requires continuous care.

6  The patient has expired (during the hospital stay or after discharge from the hospital).

Remote ischemic conditioning for acute stroke

In a randomized, sham-controlled study published in the Journal of the American Medical Association (JAMA), researchers investigated the effect of remote ischemic conditioning (RIC) on functional outcomes in patients with acute stroke in a combined prehospital and in-hospital setting.

They found that at 90 days, RIC treatment did not significantly improve functional outcomes in patients with acute stroke compared to the control group.

Study: Remote Ischemic Conditioning for Acute Stroke. Image Credit: SewCreamStudio/Shutterstock.comStudy: Remote Ischemic Conditioning for Acute Stroke. Image Credit: SewCreamStudio/Shutterstock.com

Background

RIC with transient cycles of limb ischemia and reperfusion is a simple, noninvasive intervention to minimize the risk of ischemic injury to the affected organs. In preclinical studies on intracerebral hemorrhage models, RIC enhances collateral blood flow in the ischemic area and reduces poststroke inflammation.

In clinical trials, RIC was found to be safe, feasible, and effective after 48 hours of stroke. RIC is also shown to be associated with increased hematoma resorption.

However, evidence remains inconclusive on the effectiveness of RIC as a treatment option for acute stroke. Therefore, the present clinical trial aimed to determine whether RIC started in the prehospital setting and repeated in the hospital could improve functional outcomes in patients diagnosed with acute ischemic or hemorrhagic stroke.

About the study

The “remote ischemic conditioning in patients with acute stroke trial” (RESIST) was a randomized, double-blinded, sham-controlled trial conducted at four different centers in Denmark between March 2018 and November 2022, and a follow-up was conducted in February 2023.

The study included 1,500 adult patients who presented to the hospital within four hours of stroke symptoms, as indicated by a prehospital stroke score (PreSS) of one or greater.

The exclusion criteria were a history of intracranial aneurysm, cerebral neoplasm, arteriovenous malformation, brain abscess, progressive neurodegenerative disease, severe peripheral arterial disease in the upper extremities, or the presence of an arteriovenous shunt in the arm selected for RIC.

The “target population” was patients receiving an in-hospital diagnosis of acute ischemic stroke or intracerebral hemorrhage.

The patients were randomized 1:1 to receive either RIC (n= 749) or sham (n= 751) on one upper extremity using an inflatable cuff. The procedure involved five cycles: cuff inflation (five minutes) followed by deflation (five minutes).

The cuff pressure in the RIC was 200 mmHg, while that in the sham was 20 mmHg. The treatment was initiated in the ambulance and performed again in the hospital at least once. Patients with a target diagnosis were treated twice daily for seven days.

The improvement in functional outcome at 90 days was the primary efficacy endpoint in the target population, measured as a favorable shift in the modified Rankin scale (mRS) score, where 0 implies no symptoms and a score of 6 implies death.

The secondary endpoints were a change in PreSS at 24 hours, severe adverse cardiac or cerebral events at 90 days, recurrent ischemic events, early neurological improvement, length of hospital stay, and all-cause mortality at 90 days.

The statistical analysis involved using Kaplan-Meier curves, Aalen-Johansen curves, and the estimation of odds ratio, relative risks, and difference in means.

Results and discussion

Out of the 1,500 included patients, 1,433 could complete the trial. The mean age of the patients was 71 years, and 41% of them were females. The target population consisted of 902 patients, with 436 in the RIC group and 466 in the sham group.

About 82% of the target population had acute ischemic stroke, while 18% had intracerebral hemorrhage. The two groups were similar regarding the baseline demographic, reperfusion rates, and clinical characteristics. About 90% of patients adhered to the treatment in the target population.

At 90 days, the median mRS score was estimated to be 2 in the RIC group, while that of the sham group was 1 (odds ratio = 0.95). Thus, as per the study, the RIC treatment did not significantly improve functional outcomes in the target population.

The secondary efficacy outcomes, mortality, and serious adverse events did not significantly differ among the two groups.

In a per-protocol analysis conducted on adherent patients, the results obtained were similar to the primary research in the target population. While the study has several limitations, the findings do not demonstrate significant benefits from RIC when applied in patients with acute stroke.

Conclusion

As per the study findings, RIC initiated in prehospital settings and continued in the hospital did not improve functional outcomes significantly at 90 days in patients with a confirmed diagnosis of acute ischemic stroke or intracerebral hemorrhage.

These results suggest that RIC may not be an effective standalone treatment for acute stroke. However, its role as an adjunctive therapy needs to be evaluated through further research.

Journal reference:
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