Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting: A Proof-of-Concept, Randomized Controlled Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-04, Vol.135 (14), p.1325-1335
• Main Authors: Zhao, Wenbo, Meng, Ran, Ma, Chun, Hou, Baojun, Jiao, Liqun, Zhu, Fengshui, Wu, Weijuan, Shi, Jingfei, Duan, Yunxia, Zhang, Renling, Zhang, Jing, Sun, Yongxin, Zhang, Hongqi, Ling, Feng, Wang, Yuping, Feng, Wuwei, Ding, Yuchuan, Ovbiagele, Bruce, Ji, Xunming
• Format: Article
• Language: English
• Subjects: Aged; Carotid Stenosis - complications; Female; Humans; Ischemic Preconditioning - methods; Male; Risk Factors; Stents - utilization; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.116.024807

Remote ischemic preconditioning (RIPC) can inhibit recurrent ischemic events effectively in patients with acute or chronic cerebral ischemia. However, it is still unclear whether RIPC can impede ischemic injury after carotid artery stenting (CAS) in patients with severe carotid artery stenosis. Subjects with severe carotid artery stenosis were recruited in this randomized controlled study, and assigned to RIPC, sham, and no intervention (control) groups. All subjects received standard medical therapy. Subjects in the RIPC and sham groups underwent RIPC and sham RIPC twice daily, respectively, for 2 weeks before CAS. Plasma neuron-specific enolase and S-100B were used to evaluate safety, hypersensitive C-reactive protein, and new ischemic diffusion-weighted imaging lesions were used to determine treatment efficacy. The primary outcomes were the presence of ≥1 newly ischemic brain lesions on diffusion-weighted imaging within 48 hours after stenting and clinical events within 6 months after stenting. We randomly assigned 189 subjects in this study (63 subjects in each group). Both RIPC and sham RIPC procedures were well tolerated and completed with high compliance (98.41% and 95.24%, respectively). Neither plasma neuron-specific enolase levels nor S-100B levels changed significantly before and after treatment. No severe adverse event was attributed to RIPC and sham RIPC procedures. The incidence of new diffusion-weighted imaging lesions in the RIPC group (15.87%) was significantly lower than in the sham group (36.51%; relative risk, 0.44; 96% confidence interval, 0.20-0.91;