title: Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis.
abstract: OBJECTIVE
  This study aims to evaluate protective effects of brief repetitive bilateral arm ischemic preconditioning (BAIPC) on stroke recurrence in patients with symptomatic atherosclerotic intracranial arterial stenosis (IAS).
  
  
  METHODS
  A total of 68 consecutive cases with symptomatic IAS, diagnosed by imaging, were enrolled in this prospective and randomized study. All patients received standard medical management. Patients in the BAIPC group (n = 38) underwent 5 brief cycles consisting of bilateral upper limb ischemia followed by reperfusion. The BAIPC procedure was performed twice daily over 300 consecutive days. Incidence of recurrent stroke and cerebral perfusion status in BAIPC-treated patients were compared with the untreated control group (n = 30).
  
  
  RESULTS
  In the control group, incidence of recurrent stroke at 90 and 300 days were 23.3% and 26.7%, respectively. In the BAIPC group, incidence of recurrent stroke was reduced to 5% and 7.9% at 90 and 300 days (p < 0.01), respectively. The average time to recovery (modified Rankin Scale score 0-1) was also shortened by BAIPC. Cerebral perfusion status, measured by SPECT and transcranial Doppler sonography, improved remarkably in BAIPC-treated brain than in control (p < 0.01).
  
  
  CONCLUSIONS
  This study provides a proof-of-concept that BAIPC may be an effective way to improve cerebral perfusion and reduce recurrent strokes in patients with IAS. Further investigation of this therapeutic approach is warranted as some patients were excluded after randomization.
authors.affiliation: Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience) Xuanwu Hospital, and Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Meng
authors.forename: Karam
authors.initials: K
authors.lastname: Asmaro
authors.forename: Lu
authors.initials: L
authors.lastname: Meng
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.forename: Chun
authors.initials: C
authors.lastname: Ma
authors.forename: Chunjiang
authors.initials: C
authors.lastname: Xi
authors.forename: Guoqing
authors.initials: G
authors.lastname: Li
authors.forename: Canghong
authors.initials: C
authors.lastname: Ren
authors.forename: Yumin
authors.initials: Y
authors.lastname: Luo
authors.forename: Feng
authors.initials: F
authors.lastname: Ling
authors.forename: Jianping
authors.initials: J
authors.lastname: Jia
authors.forename: Yang
authors.initials: Y
authors.lastname: Hua
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Wang
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.forename: Eng H
authors.initials: EH
authors.lastname: Lo
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D007511:Ischemia / Q000503:physiopathology*; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D055502:Secondary Prevention; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult