Remote ischemic preconditioning for cerebral and cardiac protection during carotid endarterectomy: results from a pilot randomized clinical trial.
Remote ischemic preconditioning (RIPC) is a physiological mechanism whereby brief ischemia-reperfusion episodes attenuate damage by subsequent prolonged ischemic insults. It reduces myocardial injury following cardiac and aortic aneurysm surgery. We aimed to determine whether RIPC affects neurological or cardiac injury following carotid endarterectomy (CEA). Patients were preconditioned using 10 minutes of lower limb ischemia-reperfusion. The primary neurological outcome was saccadic latency deterioration. The primary cardiac outcome measure was increased in serum troponin I >0.15 mg/dL. In all, 70 patients were randomized, of whom 55 completed the neurological surveillance protocol. Although there were fewer saccadic latency deteriorations in the RIPC arm, this did not reach statistical significance (32% versus 53%; P = .11). The primary cardiac outcome occurred in 1 patient in each arm (P = .97). There were no adverse events related to the preconditioning protocol. Remote ischemic preconditioning appears safe in patients with CEA. Large-scale trials are required to determine whether RIPC confers clinical benefits.
Walsh
Stewart R
SR
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. srwalsh@doctors.org.uk
Nouraei
S A
SA
Tang
Tjun Y
TY
Sadat
Umar
U
Carpenter
Roger H
RH
Gaunt
Michael E
ME
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D004739:England; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D019194:Ischemic Preconditioning / Q000009:adverse effects; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014111:Tourniquets; D016896:Treatment Outcome