Remote ischaemic conditioning for neurological disorders-a systematic review and narrative synthesis

Ali Alhashimi; Marharyta Kamarova; Sheharyar S Baig; Krishnan Padmakumari Sivaraman Nair; Tao Wang; Jessica Redgrave; Arshad Majid; Ali N Ali

doi:10.1186/s13643-024-02725-8

Remote ischaemic conditioning for neurological disorders-a systematic review and narrative synthesis

Syst Rev. 2024 Dec 19;13(1):308. doi: 10.1186/s13643-024-02725-8.

Authors

Ali Alhashimi^#¹, Marharyta Kamarova^#², Sheharyar S Baig², Krishnan Padmakumari Sivaraman Nair³, Tao Wang², Jessica Redgrave², Arshad Majid², Ali N Ali⁴

Affiliations

¹ University of Sheffield, Sheffield, UK.
² Department of Neuroscience, Geriatrics and Stroke, Sheffield Institute for Translational Neurosciences, University of Sheffield, Sheffield, UK.
³ Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁴ Department of Neuroscience, Geriatrics and Stroke, Sheffield Institute for Translational Neurosciences, University of Sheffield, Sheffield, UK. ali.ali@sheffield.ac.uk.

^# Contributed equally.

Abstract

Introduction: Remote ischaemic conditioning (RIC) refers to the use of controlled transient ischemic and reperfusion cycles, commonly of the upper or lower limb, to mitigate cellular damage from ischaemic injury. Preclinical studies demonstrate that RIC may have a neuroprotective effect and therefore could represent a novel therapeutic option in the management of neurological disorders. The aim of this review is to comprehensively describe the current clinical evidence of RIC in neurological disorders.

Methods: A computerised search of EMBASE and OVID MEDLINE was conducted from 2002 to October 2023 for randomised controlled trials (RCTs) investigating RIC in neurological diseases.

Results: A total of 46 different RCTs in 12 different neurological disorders (n = 7544) were included in the analysis. Conditions included acute ischaemic stroke, symptomatic intracranial stenosis and vascular cognitive impairment. The most commonly used RIC protocol parameters in the selected studies were as follows: cuff pressure at 200 mmHg (27 trials), 5-min cycle length (42 trials), 5 cycles of ischaemia and reperfusion (24 trials) and the application to the upper limb unilaterally (23 trials).

Conclusions: The comprehensive analysis of the included studies reveals promising results regarding the safety and therapeutic effect of RIC as an option for managing neurological diseases. Particularly, the strongest evidence supports its potential use in chronic stroke patients and vascular cognitive impairment. The neuroprotective effects of RIC, as demonstrated in preclinical studies, suggest that this therapeutic approach could extend its benefits to various other diseases affecting the nervous system. However, to establish the efficacy of RIC across different neurological disorders, further trials with larger sample sizes and more diverse patient populations are warranted. Upcoming trials are expected to provide valuable evidence that will not only confirm the efficacy of RIC in neurological disease management but also help identify the most optimal RIC regimen for specific conditions.

Keywords: Ischemic conditioning; Neurodegenerative disease; Remote ischemic conditioning; Stroke; Subarachnoid haemorrhage; Vascular dementia.

Publication types

Systematic Review

MeSH terms

Humans
Ischemic Preconditioning* / methods
Ischemic Stroke / therapy
Nervous System Diseases* / therapy
Randomized Controlled Trials as Topic