This is totally useless! You didn't create a protocol on this that survivors can bring to their therapists! You've known about this for years and have DONE NOTHING USEFUL TO HELP SURVIVORS!
Remote ischemic conditioning (19 posts to July 2018)
Remote ischemic conditioning for stroke: A critical systematic review
Abstract
Remote
ischemic conditioning (RIC) is the application of brief periods of
ischemia to an organ or tissue with the aim of inducing protection from
ischemia in a distant organ. It was first developed as a
cardioprotective strategy but has been increasingly investigated as a
neuroprotective intervention. The mechanisms by which RIC achieves
neuroprotection are incompletely understood. Preclinical studies focus
on the hypothesis that RIC can protect the brain from ischemia
reperfusion (IR) injury following the restoration of blood flow after
occlusion of a large cerebral artery. However, increasingly, a role of
chronic RIC (CRIC) is being investigated as a means of promoting
recovery following an ischemic insult to the brain. The recent
publication of two large, randomized control trials has provided promise
that RIC could improve functional outcomes after acute ischemic stroke,
and that there may be a role for CRIC in the prevention of recurrent
stroke. Although less developed, there is also proof-of-concept to
suggest that RIC may be used to reduce vasospasm after subarachnoid
hemorrhage or improve cognitive outcomes in vascular dementia. As a
cheap, well-tolerated and almost universally applicable intervention,
the motivation for investigating possible benefit(You knew of the need, YET DID NOTHING TO HELP SURVIVORS!) of RIC in patients
with cerebrovascular disease is great. In this review, we shall review
the current evidence for RIC as applied to cerebrovascular disease.
Introduction
Remote
ischemic conditioning (RIC) describes the technique of using non-lethal
ischemic stimuli in one organ or tissue to protect against lethal
ischemic events in a distant organ. Ischemic conditioning (IC) was first
demonstrated using isolated dog hearts whereby brief periods of
occlusion to the left circumflex artery were found to reduce infarct
size when the same artery was subsequently occluded for 40 min, in
comparison to non-conditioned hearts.1
Subsequently, it was shown that brief periods of ischemia applied to
the circumflex artery protected against ischemia from a 1 h occlusion of
the left anterior descending artery,2
suggesting that protection via IC is conveyed to a different part of an
organ than that supplied by the conditioned artery. This concept was
developed when brief periods of occlusion to the mesenteric artery
reduced the size of myocardial infarction following prolonged occlusion
of a coronary artery.3
While clearly an interesting phenomenon, it was difficult to imagine
this technique translating into clinical practice, given the perceived
danger of occluding blood supply to a major organ. However,
cardioprotection was subsequently demonstrated using brief periods of
ischemia to skeletal muscle.4
Thus, we arrive at the paradigm for RIC used today. Brief periods of
non-lethal ischemia are applied to a limb, with the aim of inducing
ischemic tolerance in a distant organ.
Several
protocols exist for RIC. The stimulus can be given before, during, or
after an ischemic event, referred to respectively as remote ischemic
preconditioning (RIPreC), remote ischemic perconditioning (RIPerC), and
remote ischemic postconditioning (RIPostC; see Figure 1).
Ischemia is achieved by the inflation of a blood pressure cuff to
supra-systolic pressures in one or multiple limbs. Most administration
protocols involve four to five cycles of cuff inflation for 5 min. While
early clinical studies predominantly used a single episode of RIC,
given around the time of an ischemic event, increasingly, chronic RIC
(CRIC) is used. This requires participants to carry out daily RIC as
described above for several days, weeks, or even months.
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