Efficacy of remote ischemic conditioning on improving WMHs and cognition in very elderly patients with intracranial atherosclerotic stenosis

Da Zhou, Jiayue Ding, Jingyuan Ya, Liqun Pan, Chaobo Bai, Jingwei Guan, Zhongao Wang, Kexin Jin, Qi Yang, Xunming Ji, Ran Meng, Da Zhou, Jiayue Ding, Jingyuan Ya, Liqun Pan, Chaobo Bai, Jingwei Guan, Zhongao Wang, Kexin Jin, Qi Yang, Xunming Ji, Ran Meng

Abstract

Our previous study revealed that remote ischemic conditioning (RIC) reduced the incidence of stroke or TIA in octo- and nonagenarians with intracranial atherosclerotic stenosis (ICAS). Herein, we aimed to investigate whether RIC would influence the progression of white matter hyperintensities (WMHs) and cognitive impairment in the same group of patients. Fifty-eight patients with ICAS were randomly assigned in a 1:1 ratio to receive standard medical treatment with RIC (n=30) versus sham-RIC (n=28). The RIC protocol consisted of 5 cycles of alternating 5-min ischemia and 5-min reperfusion applied in the bilateral upper arms twice daily for 300 days. The efficacy outcomes included WMHs change on T2 FLAIR sequences, estimated by the Fazekas scale and Scheltens scale, cognitive change as assessed by the MMSE and MoCA, and some clinical symptoms within 300-day follow-up. Compared with the baseline, RIC treatment significantly reduced Fazekas and Scheltens scores at both 180-day (both p<0.05) and 300-day (both p<0.01) follow-ups, whereas no such reduction was observed in the control group. In the RIC group, Fazekas scores were significantly lower at 300-day follow-up (p<0.001) while Scheltens scores were significantly lower at both 180-day and 300-day follow-ups (both p<0.001), as compared with the control group. There were statistically significant between-group differences in the overall MMSE or MoCA scores, favoring RIC at 180-day and 300-day follow-ups (all p<0.05). RIC may serve as a promising adjunctive to standard medical therapy for preventing the progression of WMHs and ameliorating cognitive impairment in very elderly patients with ICAS.

Keywords: cognitive impairment; intracranial atherosclerotic stenosis; octo- and nonagenarians; remote ischemic conditioning; white matter hyperintensities.

Conflict of interest statement

CONFLICTS OF INTEREST: Dr. Xunming Ji is one of the inventors of the electric auto-control device, which has been patented in China (ZL200820123637.X). All other authors report no disclosures relevant to the manuscript.

Figures

Figure 1
Figure 1
Changes of WMHs in the RIC group from baseline, day 180 to day 300. Compared with baseline, WMHs in the RIC group were significantly decreased at both day 180 and day 300 follow-ups.
Figure 2
Figure 2
Changes of WMHs in the control group from baseline, day 180 to day 300. In the control group, WMHs were not significantly attenuated at day 180 or day 300, when compared with baseline levels. By contrast, WMHs seemed to be increased robustly at day 300.

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