The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases

Spyros N. Vasdekis, Dimitrios Athanasiadis, Andreas Lazaris, Georgios Martikos, Aristeidis H. Katsanos, Georgios Tsivgoulis, Anastasios Machairas, Theodoros Liakakos

Research output: Contribution to journalReview article

9 Citations (Scopus)

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. We conducted a comprehensive literature review on the available published data about the potential effect of remote ischemic preconditioning in patients undergoing ischemia reperfusion injury 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, partly because preconditioning protocols, age limits, comorbidities and concomitant drug use varied significantly across the aforementioned trials. However, no severe local adverse events were observed in any patient undergoing limb or arm preconditioning, suggesting that RIPC is a safe and well tolerated procedure that may constitute a potentially promising innovative treatment in atherosclerotic diseases.

Original languageEnglish (US)
Pages (from-to)606-616
Number of pages11
JournalBrain and Behavior
Volume3
Issue number6
DOIs
StatePublished - Nov 1 2013

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Ischemic Preconditioning
Reperfusion Injury
Therapeutics
Carotid Endarterectomy
Living Donors
Carotid Stenosis
Transient Ischemic Attack
Abdominal Aortic Aneurysm
Percutaneous Coronary Intervention
Decompression
Coronary Angiography
Kidney Transplantation
Thoracic Surgery
Comorbidity
Arm
Extremities
Randomized Controlled Trials
Stroke
Kidney
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Behavioral Neuroscience

Cite this

Vasdekis, S. N., Athanasiadis, D., Lazaris, A., Martikos, G., Katsanos, A. H., Tsivgoulis, G., ... Liakakos, T. (2013). The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases. Brain and Behavior, 3(6), 606-616. https://doi.org/10.1002/brb3.161

The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases. / Vasdekis, Spyros N.; Athanasiadis, Dimitrios; Lazaris, Andreas; Martikos, Georgios; Katsanos, Aristeidis H.; Tsivgoulis, Georgios; Machairas, Anastasios; Liakakos, Theodoros.

In: Brain and Behavior, Vol. 3, No. 6, 01.11.2013, p. 606-616.

Research output: Contribution to journalReview article

Vasdekis, SN, Athanasiadis, D, Lazaris, A, Martikos, G, Katsanos, AH, Tsivgoulis, G, Machairas, A & Liakakos, T 2013, 'The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases', Brain and Behavior, vol. 3, no. 6, pp. 606-616. https://doi.org/10.1002/brb3.161
Vasdekis, Spyros N. ; Athanasiadis, Dimitrios ; Lazaris, Andreas ; Martikos, Georgios ; Katsanos, Aristeidis H. ; Tsivgoulis, Georgios ; Machairas, Anastasios ; Liakakos, Theodoros. / The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases. In: Brain and Behavior. 2013 ; Vol. 3, No. 6. pp. 606-616.
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N2 - 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. We conducted a comprehensive literature review on the available published data about the potential effect of remote ischemic preconditioning in patients undergoing ischemia reperfusion injury 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, partly because preconditioning protocols, age limits, comorbidities and concomitant drug use varied significantly across the aforementioned trials. However, no severe local adverse events were observed in any patient undergoing limb or arm preconditioning, suggesting that RIPC is a safe and well tolerated procedure that may constitute a potentially promising innovative treatment in atherosclerotic diseases.

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