| Background and Objective:Impaired cerebral autoregulation（CA）is an independent risk factor for the prognosis of patients with cerebrovascular disease.Our team has shown that remote ischemic conditioning（RIC）has a protective effect on cerebrovascular endothelial cells and thus has the potential to improve CA in patients with acute ischemic stroke（AIS）.This study builds on previous research work to investigate in depth the effect of RIC on the improvement of CA in patients undergoing intravenous thrombolysis（IVT）for AIS.Methods:This study included AIS patients who received IVT with recombinant tissue plasminogen activator（rt-PA）in the First Hospital of Jilin University from September2018 to November 2021.Patients were randomly divided into two groups: the experimental group received RIC at 200 mm Hg pressure at 6 and 18-24 hours after IVT,and the control group received RIC at 60 mm Hg pressure at the same time point.CA was monitored and recorded on days 1-2 and 7-10 in both groups,and correlated indices including Phase,Gain,and Coherence were determined by transfer function analysis（TFA）.Results:A total of 73 AIS patients with IVT（36 in the experimental group and 37 in the control group）were included in this study,and no adverse events occurred during the whole study.The results showed that（1）In the analysis of CA,we found that the Phase of the unaffected side and the affected side of the experimental group were significantly higher than the control group on the 1-2 days of onset（unaffected side:the experimental group: 43.19±19.64°,the control group: 33.51±18.73°,P=0.035;affected side: experimental group: 40.41±17.74°,control group:30.05±16.53°,P=0.012）;on the 7-10 days,the phase remained significantly higher on the unaffected and affected side of the experimental group than the control group（unaffected side: the experimental group: 42.02±18.26°,the control group:32.83±18.34°,P=0.035;affected side: experimental group: 42.98±20.02°,control group: 33.58±16.76°,P=0.033）.By further comparing the changes of CA over time,we found that there were no significant changes in the phase of the unaffected side and the affected side at 1-2 days and 7-10 days in the experimental group and the control group.（2）In the analysis of blood pressure（BP）and heart rate（HR）,we found that the systolic blood pressure（SBP）of the experimental group was lower than the control group during 7-10 days,and the difference is statistically significant（the experimental group: 131.72±17.61 mm Hg,the control group: 140.43±18.81 mm Hg,P=0.045）.（3）In the analysis of cerebral blood flow velocity（CBFV）,we found that the diastolic flow velocity（the experimental group: 50.00（40.25-65.00）cm/s,the control group: 44.00（33.50-51.50）cm/s,P=0.016）and average flow velocity（the experimental group: 68.33（52.67-83.58）cm/s,the control group: 57.00（51.00-69.00）cm/s,P=0.048）of the middle cerebral artery（MCA）on the unaffected side of the experimental group was significantly higher than the control group;the systolic velocity of MCA in the unaffected side of the experimental group during 7-10 days（the experimental group: 108.50（83.25-128.50）cm/s,the control group: 90.00（74.50-109.50）cm/s,P=0.031）and diastolic flow rate of MCA on the unaffected side（the experimental group: 48.00（39.50-58.75）cm/s,the control group: 40.00（35.50-49.50）cm/s,P=0.025）and the average flow velocity of MCA on the unaffected side（the experimental group: 69.83（55.50-80.25）cm/s,the control group: 57.33（48.17-69.83）cm/s,P=0.034）was significantly higher than the control group,and the difference was statistically significant.Conclusions:RIC is safe for AIS patients with IVT.Moreover,RIC administration twice within 24 hours after IVT significantly improved CA in AIS patients in the acute phase,and the improvement lasted for at least 7-10 days.In addition,RIC may potentially reduce BP and improve cerebral blood flow（CBF）in AIS patients with IVT,but a large number of clinical data are still needed for further verification. |
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