Remote Ischaemic Conditioning in Carotid Artery Stenting
Another Step on the Journey Toward Clinical Translatability?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- carotid arterial stenting
- remote ischemic conditioning
Article, see p 1325
Remote ischemic conditioning is a powerful and highly reproducible cytoprotective intervention demonstrable in a wide range of animal models.1 To an extent, remote ischemic conditioning—the phenomena whereby transient, nonlethal ischemia of a distal tissue bed triggers visceral prosurvival adaption against a lethal ischemic insult—has also been demonstrable in man, although the necessary landmark clinical outcome study has yet to yield the results necessary for adoption into routine clinical practice.
Remote ischemic conditioning (RIC) is such a remarkably simple intervention with such a low intrinsic cost in its most simplistic application (manual inflation/deflation of a sphygmomanometer cuff) that it is attractive to study RIC’s efficacy to mitigate ischemia-related injury in a wide range of pathologies and organ systems. This approach appears to be entirely appropriate: in a variety of experimental settings, remote ischemic conditioning has proved to be remarkably adept in attenuating ischemia/reperfusion injury in a variety of organ systems,2 including heart,3 kidney,4 liver,5 and brain.6
In the “Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting: A Proof-of-Concept, Randomized Controlled Trial” study, Zhao et al7 in this issue of Circulation present an intriguing proof-of-concept trial of RIC to ameliorate the complications of distal thromboembolization associated with elective carotid artery stenting (CAS) for severe carotid stenosis. Elective procedures are the ideal setting for ischemic preconditioning (where the conditioning stimulus is applied before the anticipated ischemic insult), and this is the first time remote ischemic preconditioning has been applied to protect the brain against an embolic complication arising from an elective vascular intervention.
CAS is preferred over carotid endarterectomy in patients with high surgical risk, and recent …