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Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment
Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for oc...
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Published in: | Neurotherapeutics 2015-07, Vol.12 (3), p.667-677 |
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creator | Meng, Ran Ding, Yuchuan Asmaro, Karam Brogan, David Meng, Lu Sui, Meng Shi, Jingfei Duan, Yunxia Sun, Zhishan Yu, Yang Jia, Jianping Ji, Xunming |
description | Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo- and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo- and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (
n
= 30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (
n
= 28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all
p
|
doi_str_mv | 10.1007/s13311-015-0358-6 |
format | article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4489956</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1712769752</sourcerecordid><originalsourceid>FETCH-LOGICAL-c639t-a346975ddb4fa782fca80bd4a054992fc2191c0eaf3e497da37bbdfba57441a63</originalsourceid><addsrcrecordid>eNqFkVFvFCEQxzdGY2vrB_DFkPjiCxYWdlleTMyl6iVN26T1mcyyw5XzFirsXeK3l72rTTUxPhBg5sd_hvlX1RvOPnDG1FnmQnBOGW8oE01H22fVMe9UR5VU-nk5ayGoqrk4ql7lvGasEUJ3L6ujutFNKxk_rtbLbO9w9JYsYhj85GPwYUWWmdyAQwJhIOfOoZ38DomLiVzZKdJ9_DIGWGGA5CFk4gO5mVL8juQ64Q7DrLTHbhPCNJbAafXCwSbj64f9pPr2-fx28ZVeXH1ZLj5dUNsKPVEQstWqGYZeOlBd7Sx0rB8ksEZqXa4119wyBCdQajWAUH0_uB4aJSWHVpxUHw-699t-xMGW0gk25j75EdJPE8GbPzPB35lV3BkpO13mUgTePwik-GOLeTKjzxY3GwgYt9lwxWs191j_H221UIKXVdB3f6HruE2hTGJPtbr8TxaKHyibYs4J3WPfnJnZdHMw3RTTzWy6mft9-_TDjy9-u1yA-gDkkgorTE9K_1P1F0KguEM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1693690544</pqid></control><display><type>article</type><title>Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment</title><source>ScienceDirect Journals</source><source>Springer Link</source><source>PubMed Central</source><creator>Meng, Ran ; Ding, Yuchuan ; Asmaro, Karam ; Brogan, David ; Meng, Lu ; Sui, Meng ; Shi, Jingfei ; Duan, Yunxia ; Sun, Zhishan ; Yu, Yang ; Jia, Jianping ; Ji, Xunming</creator><creatorcontrib>Meng, Ran ; Ding, Yuchuan ; Asmaro, Karam ; Brogan, David ; Meng, Lu ; Sui, Meng ; Shi, Jingfei ; Duan, Yunxia ; Sun, Zhishan ; Yu, Yang ; Jia, Jianping ; Ji, Xunming</creatorcontrib><description>Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo- and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo- and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (
n
= 30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (
n
= 28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all
p
< 0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (
p
< 0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo- and nonagenarians with SIAS. A multicenter trial is ongoing.
Clinical Trial Registration:
www.clinicaltrials.gov
, unique identifier: NCT01570231.</description><identifier>ISSN: 1933-7213</identifier><identifier>ISSN: 1878-7479</identifier><identifier>EISSN: 1878-7479</identifier><identifier>DOI: 10.1007/s13311-015-0358-6</identifier><identifier>PMID: 25956401</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged, 80 and over ; Arm - blood supply ; Biomedical and Life Sciences ; Biomedicine ; Blood Pressure ; Blood vessels ; Brain research ; Clinical trials ; Female ; Heart Rate ; Humans ; Inflammation - blood ; Ischemia ; Ischemic Preconditioning - adverse effects ; Ischemic Preconditioning - methods ; Magnetic resonance imaging ; Male ; Medical imaging ; Muscles - pathology ; Neurobiology ; Neurology ; Neurosciences ; Neurosurgery ; Original ; Original Article ; Patients ; Plasma ; Prospective Studies ; Skin - pathology ; Stroke ; Stroke - prevention & control ; Stroke - therapy ; Tomography ; Transient ischemic attack ; Treatment Outcome ; Ultrasonic imaging ; Veins & arteries</subject><ispartof>Neurotherapeutics, 2015-07, Vol.12 (3), p.667-677</ispartof><rights>The American Society for Experimental NeuroTherapeutics, Inc. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c639t-a346975ddb4fa782fca80bd4a054992fc2191c0eaf3e497da37bbdfba57441a63</citedby><cites>FETCH-LOGICAL-c639t-a346975ddb4fa782fca80bd4a054992fc2191c0eaf3e497da37bbdfba57441a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489956/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489956/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25956401$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meng, Ran</creatorcontrib><creatorcontrib>Ding, Yuchuan</creatorcontrib><creatorcontrib>Asmaro, Karam</creatorcontrib><creatorcontrib>Brogan, David</creatorcontrib><creatorcontrib>Meng, Lu</creatorcontrib><creatorcontrib>Sui, Meng</creatorcontrib><creatorcontrib>Shi, Jingfei</creatorcontrib><creatorcontrib>Duan, Yunxia</creatorcontrib><creatorcontrib>Sun, Zhishan</creatorcontrib><creatorcontrib>Yu, Yang</creatorcontrib><creatorcontrib>Jia, Jianping</creatorcontrib><creatorcontrib>Ji, Xunming</creatorcontrib><title>Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment</title><title>Neurotherapeutics</title><addtitle>Neurotherapeutics</addtitle><addtitle>Neurotherapeutics</addtitle><description>Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo- and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo- and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (
n
= 30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (
n
= 28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all
p
< 0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (
p
< 0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo- and nonagenarians with SIAS. A multicenter trial is ongoing.
Clinical Trial Registration:
www.clinicaltrials.gov
, unique identifier: NCT01570231.</description><subject>Aged, 80 and over</subject><subject>Arm - blood supply</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Blood Pressure</subject><subject>Blood vessels</subject><subject>Brain research</subject><subject>Clinical trials</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Inflammation - blood</subject><subject>Ischemia</subject><subject>Ischemic Preconditioning - adverse effects</subject><subject>Ischemic Preconditioning - methods</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Muscles - pathology</subject><subject>Neurobiology</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Plasma</subject><subject>Prospective Studies</subject><subject>Skin - pathology</subject><subject>Stroke</subject><subject>Stroke - prevention & control</subject><subject>Stroke - therapy</subject><subject>Tomography</subject><subject>Transient ischemic attack</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Veins & arteries</subject><issn>1933-7213</issn><issn>1878-7479</issn><issn>1878-7479</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkVFvFCEQxzdGY2vrB_DFkPjiCxYWdlleTMyl6iVN26T1mcyyw5XzFirsXeK3l72rTTUxPhBg5sd_hvlX1RvOPnDG1FnmQnBOGW8oE01H22fVMe9UR5VU-nk5ayGoqrk4ql7lvGasEUJ3L6ujutFNKxk_rtbLbO9w9JYsYhj85GPwYUWWmdyAQwJhIOfOoZ38DomLiVzZKdJ9_DIGWGGA5CFk4gO5mVL8juQ64Q7DrLTHbhPCNJbAafXCwSbj64f9pPr2-fx28ZVeXH1ZLj5dUNsKPVEQstWqGYZeOlBd7Sx0rB8ksEZqXa4119wyBCdQajWAUH0_uB4aJSWHVpxUHw-699t-xMGW0gk25j75EdJPE8GbPzPB35lV3BkpO13mUgTePwik-GOLeTKjzxY3GwgYt9lwxWs191j_H221UIKXVdB3f6HruE2hTGJPtbr8TxaKHyibYs4J3WPfnJnZdHMw3RTTzWy6mft9-_TDjy9-u1yA-gDkkgorTE9K_1P1F0KguEM</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Meng, Ran</creator><creator>Ding, Yuchuan</creator><creator>Asmaro, Karam</creator><creator>Brogan, David</creator><creator>Meng, Lu</creator><creator>Sui, Meng</creator><creator>Shi, Jingfei</creator><creator>Duan, Yunxia</creator><creator>Sun, Zhishan</creator><creator>Yu, Yang</creator><creator>Jia, Jianping</creator><creator>Ji, Xunming</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150701</creationdate><title>Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment</title><author>Meng, Ran ; Ding, Yuchuan ; Asmaro, Karam ; Brogan, David ; Meng, Lu ; Sui, Meng ; Shi, Jingfei ; Duan, Yunxia ; Sun, Zhishan ; Yu, Yang ; Jia, Jianping ; Ji, Xunming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c639t-a346975ddb4fa782fca80bd4a054992fc2191c0eaf3e497da37bbdfba57441a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged, 80 and over</topic><topic>Arm - blood supply</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Blood Pressure</topic><topic>Blood vessels</topic><topic>Brain research</topic><topic>Clinical trials</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Inflammation - blood</topic><topic>Ischemia</topic><topic>Ischemic Preconditioning - adverse effects</topic><topic>Ischemic Preconditioning - methods</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Muscles - pathology</topic><topic>Neurobiology</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Plasma</topic><topic>Prospective Studies</topic><topic>Skin - pathology</topic><topic>Stroke</topic><topic>Stroke - prevention & control</topic><topic>Stroke - therapy</topic><topic>Tomography</topic><topic>Transient ischemic attack</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meng, Ran</creatorcontrib><creatorcontrib>Ding, Yuchuan</creatorcontrib><creatorcontrib>Asmaro, Karam</creatorcontrib><creatorcontrib>Brogan, David</creatorcontrib><creatorcontrib>Meng, Lu</creatorcontrib><creatorcontrib>Sui, Meng</creatorcontrib><creatorcontrib>Shi, Jingfei</creatorcontrib><creatorcontrib>Duan, Yunxia</creatorcontrib><creatorcontrib>Sun, Zhishan</creatorcontrib><creatorcontrib>Yu, Yang</creatorcontrib><creatorcontrib>Jia, Jianping</creatorcontrib><creatorcontrib>Ji, Xunming</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurotherapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meng, Ran</au><au>Ding, Yuchuan</au><au>Asmaro, Karam</au><au>Brogan, David</au><au>Meng, Lu</au><au>Sui, Meng</au><au>Shi, Jingfei</au><au>Duan, Yunxia</au><au>Sun, Zhishan</au><au>Yu, Yang</au><au>Jia, Jianping</au><au>Ji, Xunming</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment</atitle><jtitle>Neurotherapeutics</jtitle><stitle>Neurotherapeutics</stitle><addtitle>Neurotherapeutics</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>12</volume><issue>3</issue><spage>667</spage><epage>677</epage><pages>667-677</pages><issn>1933-7213</issn><issn>1878-7479</issn><eissn>1878-7479</eissn><abstract>Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo- and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo- and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (
n
= 30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (
n
= 28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all
p
< 0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (
p
< 0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo- and nonagenarians with SIAS. A multicenter trial is ongoing.
Clinical Trial Registration:
www.clinicaltrials.gov
, unique identifier: NCT01570231.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>25956401</pmid><doi>10.1007/s13311-015-0358-6</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged, 80 and over Arm - blood supply Biomedical and Life Sciences Biomedicine Blood Pressure Blood vessels Brain research Clinical trials Female Heart Rate Humans Inflammation - blood Ischemia Ischemic Preconditioning - adverse effects Ischemic Preconditioning - methods Magnetic resonance imaging Male Medical imaging Muscles - pathology Neurobiology Neurology Neurosciences Neurosurgery Original Original Article Patients Plasma Prospective Studies Skin - pathology Stroke Stroke - prevention & control Stroke - therapy Tomography Transient ischemic attack Treatment Outcome Ultrasonic imaging Veins & arteries |
title | Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment |
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