From the Stroke Centre and Department of Neurology (J.-q.A., Y.-w.C., Y.-c.G., M.W., M.-j.G., Y.-l.T., X.-y.Y., W.-f. S., C.-y.M., G.-g.L.) and Atrial Fibrillation Centre and Department of Cardiovascular Medicine (J.-q.A., G.-l L.), First Affiliated Hospital of Xi'an Jiaotong University, China; Renal Division (A.-f.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Cardiology (A.M.S.), University Heart Center Zurich, Switzerland.
Neurology. 2020 Dec 15;95(24):e3355-e3363. doi: 10.1212/WNL.0000000000010884. Epub 2020 Oct 7.
To determine the effect of remote ischemic postconditioning (RIPC) on patients with acute ischemic stroke (AIS) undergoing IV thrombolysis (IVT).
A single-center randomized controlled trial was performed with patients with AIS receiving IVT. Patients in the RIPC group were administered RIPC treatment (after IVT) during hospitalization. The primary endpoint was a score of 0 or 1 on the modified Rankin scale (mRS) at day 90. The safety, tolerability, and neuroprotection biomarkers associated with RIPC were also evaluated.
We collected data from both the RIPC group (n = 34) and the control group (n = 34). The average duration of hospitalization was 11.2 days. There was no significant difference between 2 groups at admission for the NIH Stroke Scale score ( = 0.364) or occur-to-treatment time ( = 0.889). Favorable recovery (mRS score 0-1) at 3 months was obtained in 71.9% of patients in the RIPC group vs 50.0% in the control group (adjusted odds ratio 9.85, 95% confidence interval 1.54-63.16; = 0.016). We further found significantly lower plasma S100-β ( = 0.007) and higher vascular endothelial growth factor ( = 0.003) levels in the RIPC group than in the control group.
Repeated RIPC combined with IVT can significantly facilitate recovery of nerve function and improve clinical prognosis of patients with AIS.
NCT03218293.
This study provides Class IV evidence that RIPC after tissue plasminogen activator treatment of AIS significantly increases the proportion of patients with an MRS score of 0 or 1 at 90 days.
评估远程缺血后处理（RIPC）对接受静脉溶栓（IVT）的急性缺血性脑卒中（AIS）患者的影响。
这是一项单中心随机对照试验，纳入接受 IVT 的 AIS 患者。RIPC 组患者在住院期间接受 RIPC 治疗（IVT 后）。主要终点为 90 天时改良 Rankin 量表（mRS）评分 0 或 1 分。还评估了 RIPC 相关的安全性、耐受性和神经保护生物标志物。
我们从 RIPC 组（n = 34）和对照组（n = 34）中均收集了数据。平均住院时间为 11.2 天。两组入院时 NIH 卒中量表评分（ = 0.364）或发病至治疗时间（ = 0.889）无显著差异。RIPC 组 3 个月时恢复良好（mRS 评分 0-1）的患者比例为 71.9%，对照组为 50.0%（调整比值比 9.85，95%置信区间 1.54-63.16； = 0.016）。我们还发现 RIPC 组的血浆 S100-β 水平明显更低（ = 0.007），血管内皮生长因子（VEGF）水平更高（ = 0.003）。
重复 RIPC 联合 IVT 可显著促进 AIS 患者神经功能恢复，改善临床预后。
NCT03218293。
本研究提供了 IV 级证据，表明 AIS 患者接受组织型纤溶酶原激活物治疗后进行 RIPC 可显著增加 90 天时 mRS 评分 0 或 1 分的患者比例。
