Remote Ischemic Preconditioning in Carotid PCI: Safe and Effective?

Remote ischemic preconditioning (RIPC) can prevent recurrent ischemic events in patients with acute or chronic cerebral ischemia. However, is remains unclear whether RIPC could prevent an ischemic event in the context of carotid PCI in patients with severe carotid artery stenosis.

The study included patients with severe carotid artery stenosis randomized to RIPC, vs. two control groups, a sham RIPC group and a non- intervention group.

Patients in the RIPC arm received the procedure twice a day two weeks prior carotid artery stenting (CAS), as well as patients in the sham RIPC control group.

NSE and S-100B plasma levels were measured to assess RIPC safety; C reactive protein levels and new ischemic lesions were measure with MRI to assess efficacy.

Primary end point was the presence of new lesions measured by diffusion weight imaging within 48 hours after CAS, and clinical events within 6 months.

189 were randomized in all, (63 in each arm). Both RIPC and sham RIPC were well tolerated and completed with high compliance (98.41% and 95.24% respectively). There were no significant changes of NSE or S-100B, or adverse events.

The incidence of new diffusion weight imaging lesions was significantly lower than in the RIPC group (15.87%) compared to the sham RIPC group (36.51%, p<0.01) or the control group (41.27%, p<0.01). Lesion volume also resulted significantly lower (p<0.01).

As regards post CAS clinical events, there were 1 transient ischemic attack in the RIPC group, 2 strokes in the control group, and 2 strokes and 1 transient ischemic attack in the sham RIPC group, with no statistical importance.

Conclusion

RIPC is safe before CAS and it could also reduce periprocedural events risk. However, RIPC mechanisms and effects on clinical events still call for further research.

Original Title: Safety and Efficacy of Remote Ischemic Preconditioning in Patients with Severe Carotid Artery Stenosis Prior to Carotid Artery Stenting: A Proof-of-Concept, Randomized Controlled Trial.

Reference: Wenbo Zhao et al. Circulation. 2017 Feb 7. [Epub ahead of print].

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