The Improvement Of Dynamic Cerebral Autoregulation In Patients With Intracranial And Extracranial Arteriosclerosis Treated With Remote Ischemic Conditioning

Backgroud and Objective:Remote ischemic conditioning(RIC)refers to the treatment of ischemic organ/tissue protection by giving remote tissues or organs short and repeated ischemia-reperfusion training to activate endogenous protective mechanisms of the body.Recent studies have found that,RIC has neuroprotective effects,but the mechanism is unclear.Cerebral autoregulation(CA)refers to the ability of cerebral arterioles to maintain a relatively stable cerebral blood volume by contraction or relaxation when arterial blood pressure/intracranial pressure changes.Our previous study found that RIC can improve CA in normal adults.On the basis of our previous work,this study focused on patients with worse vascular elasticity,and further explored the effect of RIC on CA in patients with intracranial and extracranial arteriosclerosis.Methods:A total of 140 patients with intracranial and extracranial arteriosclerosis admitted to the Stroke Center of the First Hospital of Jilin University from December 2022 to May 2023 were enrolled in this study.Patients were randomly assigned in a 1:1 ratio to the experimental and control groups.The experimental group received basic treatment +RIC 200 mm Hg.The control group received basic treatment plus sham treatment with RIC 60 mm Hg.CA was monitored before ischemic treatment,0-1h,6-9h and 24 h after ischemic treatment in both groups.The parameters of CA,including Phase,Gain and Coherence,were obtained by transfer function analysis.The primary outcome measure of the study was the difference between the experimental group and the control group at 6-9 hours after ischemic treatment.The secondary efficacy evaluation indexes were the difference of Phase between the experimental group and the control group at 0-1h and 24 h after ischemic treatment,and the difference of Gain at 0-1h,6-9h and 24 h after ischemic treatment.The safety indicators of the study were adverse events during the study and their occurrence time.Results:Among 140 patients with intracranial and extracranial arteriosclerosis,135 patients were finally included in the analysis(69 in the experimental group and 66 in the control group).The primary outcome of the study: the comparison of 6-9h Phase between the experimental group and the control group showed that the affected side Phase(P<0.001)and the healthy side Phase(P=0.020)in the experimental group were significantly higher than those in the control group.The secondary outcome of the study was a comparison of 0-1h Phase between the two groups,which found that the affected Phase of the experimental group was higher than that of the control group(P=0.028).In the comparison of 24 h Phase,it was found that the affected side Phase(P=0.001)and the healthy side Phase(P=0.002)in the experimental group were significantly higher than those in the control group.In the comparison of Gain,blood pressure,heart rate and middle cerebral artery flow velocity at the same time point,it was found that there was no statistically significant difference between the two groups(all P>0.05).Conclusions:1.RIC can improve CA function in patients with intracranial and extracranial arteriosclerosis,and the improvement starts immediately after RIC and can last for at least 24 hours.2.RIC has no significant effect on blood pressure and heart rate in patients with intracranial and extracranial arteriosclerosis;3.RIC had no significant effect on CBF in patients with intracranial and extracranial arteriosclerosis.