Abstract TMP104: Arm Ischemic Preconditioning Prevents Stroke Recurrence in Octogenarians with Intracranial Arterial Stenosis

Abstract

Introduction: Symptomatic atherosclerotic intracranial arterial stenosis (SAIS) has a high incidence of stroke and recurrence, especially in octogenarians. Currently available therapies including stenting are unable to prevent strokes recurrence completely and may result in worse clinical outcomes. Emerging experimental investigations have suggested that remote ischemic preconditioning may be clinically effective in stroke intervention. Hypothesis: Brief repetitive bilateral arm ischemic preconditioning (BAIPC) may be safe and prevent stroke occurrence and recurrence in octogenarians with SAIS. Methods: A total of 58 consecutive octogenarians with SIAS (diagnosed by imaging) enrolled in this prospective, single blind and randomized study. All patients enrolled underwent standard medical care. In addition, patients in BAIPC group (n=30) underwent five cycles consisting of bilateral arms 5min ischemia followed by 5min reperfusion twice daily for the total of 180 consecutive days. Blood pressure, heart rate, local skins integrity and plasma myoglobin levels before and during the first 30-days of treatment were documented. Finally, Plasma levels of thrombosis and inflammation markers, clinical outcomes (modified Rankin Scale 0-1) and the incidence of stroke recurrence during the180-days of treatment in the two groups were compared. Clinical Trial Registration-URL: www.clinicaltrials.gov , unique identifier: NCT01570231 . Results: Compared to the controls (n=28), BAIPC had no adverse effects on blood pressure, heart rate, local skins integrity and plasma myoglobin, and BAIPC did not contribute to cerebral hemorrhage. BAIPC decreased plasma levels of hsCRP, IL-6, PAI-1, leukocyte count, platelet aggregation rate as well as increased TPA, improved the 180-days of modified Rankin Scale and decreased the incidences of ischemic stroke recurrence and TIA onset (6.7% and 23.3% in BAIPC group versus 28.6% and 39.3% in control group, P < 0.01). Conclusions: Our study provides a proof-of-concept that BAIPC is a safe and feasible method to protect the ischemic brain in octogenarians with SIAS. Further investigation in an enlarged trial is ongoing.