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Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke

Citation

Li, Guoliang et al. (2022), Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke, Dryad, Dataset, https://doi.org/10.5061/dryad.zw3r2286c

Abstract

Objective: To determine the effect of remote ischemic post-conditioning (RIPC) on acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT).

Methods: A single-center, randomized controlled trial was performed with AIS patients receiving IVT. Patients in the RIPC group were administered RIPC treatment (after IVT) during hospitalization. The primary endpoint was a score of 0 or 1 on the modified Rankin scale (mRS) at day 90. The safety, tolerability and neuroprotection biomarkers associated with RIPC were also examined.

Results: We collected data from both RIPC (n=34) and controls (n=34). The average duration of hospitalization was 11.2 days. There was no significant difference between the two groups at admission for the NIHSS score (p=0.364) or occur to treatment time (p=0.889). An excellent recovery (mRS 0–1) at 3 months was obtained in 71.9% of the patients in the RIPC group vs 50.0% in the control group (adjusted risk ratio, 9.85; 95% CI, 1.54 to 63.16; P = 0.016). We further found significantly lower plasma S100 β (p=0.007) and higher vascular endothelial growth factor (p = 0.003) levels in the RIPC group than in controls.

Conclusions: Repeated RIPC combined with IVT can significantly facilitate recovery of nerve function and improve clinical prognosis of patients with AIS.

Methods

The baseline characteristics of patients with acute ischemic stroke was collectd  before IV tPA. National Institutes of Health Stroke Scale (NIHSS), the Barthel index (BI) and the modified Rankin Score (mRS) were measured before IV tPA, at discharge and at 90 days after stroke. we also collected the safety markers such as the three-month mortality, the incidence of any symptomatic hemorrhagic transformation (sICH) (European Cooperative Acute Stroke Study III classification) and early neurological deterioration (END: NIHSS increase ≥4 between baseline and 24 h post-baseline). Venous blood was drawn before the administration of IV tPA and at the end of hospitalization.Plasma biomarker concentrations were blindly assessed by quantitative sandwich ELISA kits (Uscn Life Science, Wu Han, China) on previously frozen (stored at −80°C) blood samples.

All statistical analysis was performed using the SPSS 18.0 statistical package. Discrete variables were represented as frequencies and percentages, and were compared using a Chi-squared test. Distribution of continuous variables was examined using a Kolmogorov–Smirnov test. 95% confidence intervals (CI) and odds ratios (OR) were analyzed by binary logistic regression for the primary and secondary outcomes, taking prespecified adjustment variables (age, baseline NIHSS and mRS) into account. Continuous variables were compared using an ANCOVA (analysis of covariance) or independent Student’s t-tests. The risk ratio for the primary and secondary outcome was adjusted for age and stroke severity (baseline NIHSS score). For all analyses, a two-sided p<0.05 was considered statistically significant.

Funding

First Affiliated Hospital of Xi'an Jiaotong University, Award: XJTU1AF-CRF-2018-015

First Affiliated Hospital of Xi'an Jiaotong University, Award: XJTU1AF-CRF-2016-013

First Affiliated Hospital of Xi'an Jiaotong University, Award: XJTU1AF-CRF-2018-015