title: The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) is the application of a transient and brief ischemic stimulus to a distant site from the organ or tissue that is afterward exposed to injury ischemia, and has been found to reduce ischemia-reperfusion injury (IRI) in various animal models. RIPC appears to offer two distinct phases of endothelial IRI protection, which are presumably mediated through neuronal and humoral pathways.
  
  
  METHODS
  We conducted a comprehensive literature review on the available published data about the potential effect of RIPC in patients undergoing IRI in one or more vital organs.
  
  
  RESULTS
  Our search highlighted 24 randomized clinical trials about the effect of RIPC on variable clinical settings (abdominal aortic aneurysm repair, open heart surgery, percutaneous coronary intervention, living donor renal transplantation, coronary angiography, elective decompression surgery, carotid endarterectomy, recent stroke, or transient ischemic attack combined with intracranial carotid artery stenosis). Most of the trials focused on postoperative cardiac or renal function after RIPC with conflicting results. Preconditioning protocols, age limits, comorbidities, and concomitant drug use varied significantly across trials, and therefore no firm conclusions can be drawn using the available data. However, no severe local adverse events were observed in any patient undergoing limb or arm preconditioning.
  
  
  CONCLUSIONS
  RIPC is a safe and well-tolerated procedure that may constitute a potentially promising innovative treatment in atherosclerotic diseases. Large, multicenter, randomized clinical trials are required to determine an optimal protocol for the RIPC procedure, and to evaluate further the potential benefits of RIPC in human ischemic injury.
authors.affiliation: Vascular Unit, Third Department of Surgery, School of Medicine Athens, University of Athens Athens, Greece.
authors.forename: Spyros N
authors.initials: SN
authors.lastname: Vasdekis
authors.affiliation: Vascular Unit, Third Department of Surgery, School of Medicine Athens, University of Athens Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Athanasiadis
authors.affiliation: Vascular Unit, Third Department of Surgery, School of Medicine Athens, University of Athens Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lazaris
authors.affiliation: Third Department of Surgery, University of Athens, School of Medicine Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Martikos
authors.affiliation: Department of Neurology, University of Ioannina, School of Medicine Ioannina, Greece.
authors.forename: Aristeidis H
authors.initials: AH
authors.lastname: Katsanos
authors.affiliation: Second Department of Neurology, University of Athens, School of Medicine Athens, Greece ; International Clinical Research Center, St. Anne's University Hospital in Brno Czech Republic.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: Third Department of Surgery, University of Athens, School of Medicine Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
authors.affiliation: Third Department of Surgery, University of Athens, School of Medicine Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Liakakos
keywords: Aortic aneurysm; atherosclerosis; coronary artery disease; ischemic stroke; peripheral arterial disease; remote ischemic preconditioning