| Background and Objective:Cerebral autoregulation(CA)reflects the ability of the brain to maintain a relatively constant cerebral blood flow,mainly through contraction or relaxation of intracranial arterioles,is the body’s internal self-protection mechanism.Impaired cerebral autoregulation is common in patients and closely related to complications such as hemorrhagic transformation and poor prognosis with acute ischemic stroke(AIS).Our team has found remote ischemic conditioning treatments(RIC)administration twice within 24 hours can effectively improve CA undergoing intravenous thrombolysis,and the improvement lasted for at least7-10 days.The purpose of this study is to further explore the effect of serial RIC on CA in AIS patients receiving intravenous thrombolysis on the basis.Methods:This study included AIS patients who received intravenous thrombolysis(IVT)with recombinant tissue plasminogen activator(rt-PA)in Stroke Center,the First Hospital of Jilin University from September 2021 to November 2022.Patients were randomized 1:1 to experimental or control groups: The experimental group received standard medical treatment and RIC induced by inflation of a blood pressure cuff to 200 mm Hg of healthy upper limb ischemia within 6 hours after thrombolysis,2 times per day for 7 consecutive days and 14 times in total.The control group received standard medical treatment and RIC at60 mm Hg pressure at the same time point.CA was monitored and recorded on days 0-1,3-4 and 7 in both groups,and correlated indices including Phase,Gain,and Coherence were determined by transfer function analysis.Results:The data of 60 AIS patients undergoing IVT(30 in the experimental group and 30 in the control group)were included in this study,excluding 1 patient intolerance to RIC treatment(1 in the experimental group),7 patients failing to complete 3 times of d CA(3 in the experimental group and 4 in the control group)and 2 patients coherence≤0.34(2 in the experimental group),10 patients dropped out.Finally,50 AIS patients undergoing IVT(24 in the experimental group and26 in the control group)were enrolled in this study and no adverse events occurred during the whole study.The results showed that(1)In the analysis of CA,the inter group effect(F=5.072,P=0.029)about the Phase of the unaffected side in the two groups were statistically significant,the Phase of the unaffected side in the experimental group were significantly higher than the control group.(2)In the analysis of cerebral blood flow velocity(CBFV),we found that the time effect about the systolic flow velocity(F=8.945,P<0.001),the diastolic flow velocity(F=11.273,P<0.001)and the mean flow velocity(F=11.310,P<0.001)of the middle cerebral artery(MCA)in the unaffected side of the two groups were statistically significant.The systolic flow velocity,diastolic flow velocity and mean flow velocity of MCA in the unaffected side increased after monitoring CBFV.The inter group effect about the systolic flow velocity(F=5.443,P=0.024),the diastolic flow velocity(F=4.453,P=0.040)and the mean flow velocity(F=5.364,P=0.025)of MCA in the unaffected side of the two groups were statistically significant.The systolic flow velocity,diastolic flow velocity and mean flow velocity of MCA in the unaffected side of the experimental group was higher than the control group.(3)In the analysis of blood pressure,we found that the time effect about the systolic blood pressure(F=4.094,P=0.020)and pulse pressure(F=6.505,P=0.002)of the two groups were statistically significant,the systolic blood pressure and pulse pressure reduced in both experimental and control groups after monitoring blood pressure.Conclusions:Serial RIC after intravenous thrombolysis significantly improved cerebral autoregulation in AIS patients in the acute phase.Serial RIC after intravenous thrombolysis may potentially improve cerebral blood flow in AIS patients.RIC is safe for AIS patients with intravenous thrombolysis. |
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