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. 2019 Jan 16;6(2):364-372.
doi: 10.1002/acn3.713. eCollection 2019 Feb.

rt-PA with remote ischemic postconditioning for acute ischemic stroke

Ruiwen Che  1   2 , Wenbo Zhao  1   2 , Qingfeng Ma  1 , Fang Jiang  1   2 , Longfei Wu  1 , Zhipeng Yu  1 , Qian Zhang  1 , Kai Dong  1 , Haiqing Song  1 , Xiaoqin Huang  1 , Xunming Ji  2   3
Affiliations

rt-PA with remote ischemic postconditioning for acute ischemic stroke

Ruiwen Che et al. Ann Clin Transl Neurol. .

Abstract

Objective: To investigate the feasibility and safety of remote ischemic postconditioning (RIPC) in acute ischemic stroke patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis (IVT).

Methods: We performed a pilot randomized trial involving acute ischemic stroke patients with IVT. The patients were randomized 1:1 to receive RIPC or standard medical therapy. In the RIPC group, the participants underwent instant RIPC within 2 h of IVT, followed by repeated RIPC therapy for 7 days. The feasibility end point was the completion of RIPC and time from the first RIPC to finishing IVT in the RIPC group. The safety end point included tissue and neurovascular injury resulting from RIPC, changes in vital signs, level of plasma myoglobin, any hemorrhagic transformation, and other adverse events.

Results: Thirty patients (15 RIPC and 15 Control) were recruited after IVT. The mean age was 65.7 ± 10.2 years, with a National Institutes of Health Stroke Scale (NIHSS) score of 6.5 (4.0-10.0). The completion rate for RIPC was 97.0%. The mean time from first RIPC to completing IVT was 66.0 (25.0-75.0) min in the RIPC group. One case of hemorrhagic transformation was observed in the RIPC group. No significant difference was found in the level of myoglobin between the two groups (P > 0.05).

Interpretation: RIPC is effective and safe for AIS patients after intravenous rt-PA thrombolysis.

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Conflict of interest statement

Dr. Xunming Ji is one of the inventors of the electric autocontrol device that has been patented in China (ZL201420846209.5, China). The other authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Trial profile. RIPC, remote ischemic postconditioning.
Figure 2
Figure 2
The objective signs of tissue or neurovascular injury. (A, B). the pinpoint‐like erythema at the superior part of upper arm.
Figure 3
Figure 3
Cardiovascular parameters during 7 days of RIPC treatment (n = 15). (A). The black curve represents blood pressure immediately before RIPC, and the red curve represents blood pressure at 15 min after RIPC. (B) The black curve represents the heart rate immediately before RIPC, and the red curve represents the heart rate at 15 min after RIPC.
See this image and copyright information in PMC

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