ESOC 2024 | REMOTE-CAT: remote ischemic perconditioning shows benefit in acute ischemic stroke
Francisco Purroy, PhD, Institut de Recerca Biomèdica de Lleida, Lleida, Spain, shares the results of the REMOTE-CAT project, which investigated the impact of remote ischemic perconditioning (RIPerC) as a novel neuroprotective strategy for patients with acute ischemic stroke. RIPerC employs brief episodes of transient limb ischemia in an effort to upregulate endogenous defense systems to achieve ischemic tolerance and thus, mitigate cerebral damage. In REMOTE-CAT, patients from four centers in Catalonia were treated with five cycles of RIPerC or sham stimulation in the ambulance. At 90 days post-stroke, mRS 0-2 was achieved by 64.9% in the RIPerC arm, compared to 47% in the sham arm. The improvement was strongest in those with lower NIHSS scores and those without large vessel occlusion. This interview took place at the 10th European Stroke Organisation Conference (ESOC) 2024 in Basel, Switzerland.
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Transcript
Remote ischemic perconditioning is a new strategy of neuroprotection and it consists of different cycles of compression-depression on the limb and this promotes or induces the ischemic tolerance. So it’s is a new paradigm of neuroprotection that is safe and inexpensive and what is interesting is that you can apply it in the prehospital setting. So we include patients in the prehospital setting, in the ambulance, and then we apply the RIC and also there was another arm that was a sham...
Remote ischemic perconditioning is a new strategy of neuroprotection and it consists of different cycles of compression-depression on the limb and this promotes or induces the ischemic tolerance. So it’s is a new paradigm of neuroprotection that is safe and inexpensive and what is interesting is that you can apply it in the prehospital setting. So we include patients in the prehospital setting, in the ambulance, and then we apply the RIC and also there was another arm that was a sham. Patients were randomized in the prehospital setting and then they will assign to the active group and to the sham group. In our case, RIC consisted of five cycles of five minutes of ischemic perconditioning and then at the arrival of the hospital we confirmed the diagnosis. Our target was ischemic stroke patients and then our primary point was the proportion of patients with good outcomes, which means modified Rankin Scale less than three at 90 days. Also there was a sub-study of neuroimaging in our clinical trial.
First, I think that doing an academic clinical trial is a great challenge and we are very happy with having these results. In our study, we observed that remote ischemic conditioning is more efficient in those patients with low severity stroke and also in those patients without large vessel occlusion which was something that we didn’t expect at the initiation of the of the clinical trial. So we have these results last week and then we have to think how our results could change now the way we are treating patients.
Obviously our study had some difficulties. First the pandemic that slowed the recruitment. Obviously the insufficient funding, so we prematurely concluded the study not with the number of patients that we tried include. But with these 200 patients, we observe these results so we think that remote ischemic conditioning could improve the neurological evolution of our patients especially in those patients that initially have low severity symptoms and without large vessel occlusion. Maybe remote ischemic conditioning could act in the post reperfusion therapy.
We think that we need new clinical trials to confirm our results or maybe to focus on this kind of patients… patients that have reperfusion and maybe remote ischemic conditioning could avoid reperfusion injury so this is our theory. In terms of neuroimaging, we observed that there were differences in infarct volume. In the sham group, the volumes were higher than in the active group, but the differences did not reach statistical significance. I think that our study was underpowered with this limitation of patients. But we are happy because we have finished the study and it was a large path to get to here and I think that maybe in future clinical trials we could we could focus in a special patient characteristics. We have determined the modified Rankin Score at 90 days but also we have performed in parallel a study of cognition repercussions and also affective symptoms and maybe it would be interesting to follow up these patients in one year.
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