Remote Ischemic Preconditioning to Prevent Delayed Cerebral Ischemia Due to Vasospasm in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND

Remote ischemic preconditioning (RIPC) has shown potential in reducing vasospasm-induced secondary ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Research suggests RIPC may help the brain adapt to periods of reduced blood flow, thereby reducing the risk of cerebral infarction secondary to delayed cerebral ischemia. This study aimed to analyze the possible impact of RIPC in patients with vasospasm following aSAH.

METHODS

We performed a prospective, randomized, controlled, and rater-masked trial at our high-volume neurovascular center. Patients treated for aSAH between November 2019 and September 2023 were randomly allocated to either the control or RIPC intervention group. The RIPC intervention involved three upper arm blood pressure cuff inflations (20 mm Hg above systolic pressure) for 5 min, followed by 5 min of reperfusion, administered for 10 consecutive days within the initial 14 days after aSAH. The primary end point was postinterventional computed tomography to identify new cerebral infarction areas.

RESULTS

Among 60 patients (29 in the intervention group, 31 in the control group) the entire cohort averaged 62.0 years, with no significant age difference between groups (p = 0.41). RIPC did not significantly affect the initial occurrence of symptomatic vasospasms or the incidence of cerebral infarctions (RIPC 24.1% vs. control 16.1%, p = 0.44). No significant difference was found between the two groups with respect to incidence of new neurological symptoms (p = > 0.99) or in-hospital mortality (p = 0.5).

CONCLUSIONS

Remote ischemic preconditioning does not appear to influence the occurrence of vasospasms or the development of new infarcts on computed tomography. Larger studies are needed to further explore whether RIPC may have a role in specific high-risk subgroups or clinical settings.