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. 2023 Jul 28:14:1200534.
doi: 10.3389/fneur.2023.1200534. eCollection 2023.

Safety and efficacy of remote ischemic conditioning in adult moyamoya disease patients undergoing revascularization surgery: a pilot study

Heng Yang #  1   2   3   4   5 , Zhenzhen Hu #  6 , Xinjie Gao #  1   2   3   4   5 , Jiabin Su  1   2   3   4 , Hanqiang Jiang  1   2   3   4 , Shaoxuan Yang  5 , Qing Zhang  6 , Wei Ni  1   2   3   4   5 , Yuxiang Gu  1   2   3   4   5
Affiliations

Safety and efficacy of remote ischemic conditioning in adult moyamoya disease patients undergoing revascularization surgery: a pilot study

Heng Yang et al. Front Neurol. .

Abstract

Background and purpose: Revascularization surgery for patients with moyamoya disease (MMD) is very complicated and has a high rate of postoperative complications. This pilot study aimed to prove the safety and efficacy of remote ischemic conditioning (RIC) in adult MMD patients undergoing revascularization surgery.

Methods: A total of 44 patients with MMD were enrolled in this single-center, open-label, prospective, parallel randomized study, including 22 patients assigned to the sham group and 22 patients assigned to the RIC group. The primary outcome was the incidence of major neurologic complications during the perioperative period. Secondary outcomes were the modified Rankin Scale (mRS) score at discharge, at 90 days post-operation, and at 1 year after the operation. The outcome of safety was the incidence of adverse events associated with RIC. Blood samples were obtained to monitor the serum concentrations of cytokines (VEGF, IL-6).

Results: No subjects experienced adverse events during RIC intervention, and all patients could tolerate the RIC intervention in the perioperative period. The incidence of major neurologic complications was significantly lower in the RIC group compared with the control group (18.2% vs. 54.5%, P = 0.027). The mRS score at discharge in the RIC group was also lower than the control group (0.86 ± 0.99 vs. 1.18 ± 1.22, P = 0.035). In addition, the serum IL-6 level increased significantly at 7 days after bypass surgery in the control group and the serum level of VEGF at 7 days post-operation in the RIC group.

Conclusion: In conclusion, our study demonstrated the neuroprotective effect of RIC by reducing perioperative complications and improving cerebral blood flow in adult MMD patients undergoing revascularization surgery. Thus, RIC seems to be a potential treatment method for MMD.

Clinical trial registration: ClinicalTrials.gov, identifier: NCT05860946.

Keywords: complications; modified Rankin Scale (mRS); moyamoya disease; remote ischemic conditioning; revascularization surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient enrollment.
Figure 2
Figure 2
Cerebral blood flow at the baseline and 7 days after operation. Arterial spin labeling (ASL) images of the patient in both the control and RIC groups demonstrated remarkable perfusion improvement after bypass surgery, especially in the RIC group.
Figure 3
Figure 3
Changes in serum cytokines for MMD patients undergoing revascularization surgery after RIC. The serum IL-6 level increased significantly at 7 days after revascularization surgery in the control group but was not significantly different between pre- and post-operation in the RIC group (A). RIC could also significantly elevate the level of VEGF at 7 days post-operation in the RIC group, but the change of the VEGF level had no obvious difference after operation in the control group (B) (*P < 0.05, **P < 0.01 vs. baseline).
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