REMOTE Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: REMOTE-CAT PROJECT

 Well fuck three different methods have had research out there for years.  You'll have to ask your doctor the difference between perconditioning and preconditioning.

If your stroke hospital has done nothing with any.

• leg compressions (13 posts to August 2012)

• leg wraps (5 posts to May 2013)

• External counterpulsation (4 posts to August 2013)  

NOTHING?

Then get that doctor, the stroke department head, the president and the board of directors fired. FOR INCOMPETENCE!

The latest here:

REMOTE Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: REMOTE-CAT PROJECT

Francisco Purroy^1,2*†, Gloria Arque^2†, Gerard Mauri^1,2, Cristina García-Vázquez², Mikel Vicente-Pascual^1,2, Cristina Pereira², Daniel Vazquez-Justes^1,2, Coral Torres-Querol², Ana Vena^1,2, Sònia Abilleira³, Pere Cardona⁴, Carles Forné^5†, Xavier Jiménez-Fàbrega⁶, Jorge Pagola⁷, Manuel Portero-Otin⁸, Ana Rodríguez-Campello⁹, Àlex Rovira¹⁰ and Joan Martí-Fàbregas¹¹

• ¹Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
• ²Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
• ³Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
• ⁴Stroke Unit, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
• ⁵Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
• ⁶Servei d'Emergències Mèdiques, Hospitalet de Llobregat, Spain
• ⁷Stroke Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
• ⁸Department of Experimental Medicine, NUTREN-Nutrigenomics, Biomedical Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
• ⁹Neurovascular Research Group, Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
• ¹⁰Section of Neuroradiology and MRI Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
• ¹¹Stroke Unit, Hospital de Sant Pau, Barcelona, Spain

Rationale: Remote ischemic perconditioning during cerebral ischemia (RIPerC) refers to the application of brief episodes of transient limb ischemia commonly to a limb, it represents a new safe, simple and low-cost paradigm in neuroprotection.

Aim and/or Hypothesis: To evaluate the effects of RIPerC on acute ischemic stroke (AIS) patients, applied in the ambulance, to improve functional outcomes compared with standard of care.

Sample Size Estimates: A sample size of 286 patients in each arm achieves 80% power to detect treatment differences of 14% in the outcome, using a two-sided binomial test at significance level of 0.05, assuming that 40% of the control patients will experience good outcome and an initial misdiagnosis rate of 29%.

Methods and Design: We aim to conduct a multicentre study of pre-hospital RIPerC application in AIS patients. A total of 572 adult patients diagnosed of suspected clinical stroke within 8 h of symptom onset and clinical deficit >0 according to prehospital rapid arterial occlusion evaluation (RACE) scale score will be randomized, in blocks of size 4, to RIPerC or sham. Patients will be stratified by RACE score scale. RIPerC will be started in the ambulance before hospital admission and continued in the hospital if necessary. It will consist of five cycles of electronic tourniquet inflation and deflation (5 min each). The cuff pressure for RIPerC will be 200 mmHg during inflation. Sham will only simulate vibration of the device.

Study Outcome(s): The primary outcome will be the difference in the proportion of patients with good outcomes as defined by a mRS score of 2 or less at 90 days. Secondary outcomes to be monitored will include early neurological improvement rate, treatment related serious adverse event rates, size of the infarct volume, symptomatic intracranial hemorrhage, metabolomic and lipidomic response to RIPerC and Neuropsychological evaluation at 90 days.

Discussion: Neuroprotective therapies could not only increase the benefits of available reperfusion therapies among AIS patients but also provide an option for patients who are not candidates for these treatments. REMOTE-CAT will investigate the clinical benefit of RIC as a new neuroprotective strategy in AIS.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03375762.

Introduction and Rationale

Stroke is one of the leading causes of death worldwide and the main cause of disability (1). Currently, the only therapies for acute ischemic stroke (AIS) patients are the administration of rt-PA (2) and/or endovascular treatment (3). Unfortunately, many patients cannot benefit from these therapies due to their contraindications or evolution time. Neuroprotective therapies could not only increase the benefits of available reperfusion therapies but also provide an option for patients who are not candidates for these treatments (4). However, most neuroprotection trials have so far failed to demonstrate their efficacy in AIS patients, despite promising results in animal studies (4). Remote ischemic perconditioning (RIPerC) represents a new paradigm in neuroprotection (5). It potential upregulates endogenous defense systems to achieve ischemic tolerance in brain ischemia (6). It consists of brief episodes of transient limb ischemia. According to studies in coronary ischemia, RIPerC during the ischemic event is safe, feasible, and related to a decrease in myocardial injury (7). However, there is limited data about the clinical utility of RIPerC in AIS patients. Only four randomized clinical trials (RCTs) have been completed and published (8–11). All of them demonstrated that RIC is safe and feasible in AIS. One has been conducted to test RIPerC in a prehospital setting in AIS patients and as an adjunct treatment with intravenous alteplase (11). Two other small-size studies were only designed to evaluate the safety and feasibility of RIC in AIS patients recruited within 24 h of onset of symptoms (8) and in alteplase treated patients (9). The last and the largest study included 188 patients with confirmed carotid ischemic stroke within 6 h of symptoms onset (10). None of them demonstrated a significant clinical effect or a significant effect on brain infarction volume growth.

We aim to conduct a multicentre study of pre-hospital RIPerC in AIS patients applied within 8 h of stroke onset. Our hypothesis is that RIPerC would be safe and would induce endogenous neuroprotective phenomena associated with good outcomes in AIS patients treated with revascularization therapies or not.