Remote Ischemic Perconditioning as an Adjunct Therapy to Thrombolysis in Patients With Acute Ischemic Stroke

医学 溶栓 冲程(发动机) 半影 梗塞 缺血 脑缺血 脑梗塞 麻醉 内科学 外科 心肌梗塞 机械工程 工程类
作者
Kristina Dupont Hougaard,Niels Hjort,D Zeidler,Leif H. Sørensen,A. Nørgaard,Troels Martin Hansen,Paul von Weitzel-Mudersbach,Claus Z. Simonsen,Dorte Damgaard,Hanne Gottrup,Kristina B. Svendsen,Peter Vestergaard Rasmussen,Lars Ribe,Irene Klærke Mikkelsen,Kartheban Nagenthiraja,Tae‐Hee Cho,Andrew N. Redington,Hans Erik Bøtker,Leif Østergaard,Kim Mouridsen
出处
期刊:Stroke [Ovid Technologies (Wolters Kluwer)]
卷期号:45 (1): 159-167 被引量:258
标识
DOI:10.1161/strokeaha.113.001346
摘要

Background and Purpose— Remote ischemic preconditioning is neuroprotective in models of acute cerebral ischemia. We tested the effect of prehospital rPerC as an adjunct to treatment with intravenous alteplase in patients with acute ischemic stroke. Methods— Open-label blinded outcome proof-of-concept study of prehospital, paramedic-administered rPerC at a 1:1 ratio in consecutive patients with suspected acute stroke. After neurological examination and MRI, patients with verified stroke receiving alteplase treatment were included and received MRI at 24 hours and 1 month and clinical re-examination after 3 months. The primary end point was penumbral salvage, defined as the volume of the perfusion–diffusion mismatch not progressing to infarction after 1 month. Results— Four hundred forty-three patients were randomized after provisional consent, 247 received rPerC and 196 received standard treatment. Patients with a nonstroke diagnosis (n=105) were excluded from further examinations. The remaining patients had transient ischemic attack (n=58), acute ischemic stroke (n=240), or hemorrhagic stroke (n=37). Transient ischemic attack was more frequent ( P =0.006), and National Institutes of Health Stroke Scale score on admission was lower ( P =0.016) in the intervention group compared with controls. Penumbral salvage, final infarct size at 1 month, infarct growth between baseline and 1 month, and clinical outcome after 3 months did not differ among groups. After adjustment for baseline perfusion and diffusion lesion severity, voxelwise analysis showed that rPerC reduced tissue risk of infarction ( P =0.0003). Conclusions— Although the overall results were neutral, a tissue survival analysis suggests that prehospital rPerC may have immediate neuroprotective effects. Future clinical trials should take such immediate effects, and their duration, into account. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00975962.
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