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Safety and efficacy of remote ischemic conditioning in pediatric moyamoya disease patients treated with revascularization therapy
Sijie Li1, Wenbo Zhao2, Cong Han3, Gary B Rajah4, Changhong Ren1, Jiali Xu2, Shuling Shang2, Ran Meng5, Yuchuan Ding4, Xunming Ji6
1 Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University; Beijing Municipal Geriatric Medical Research Center, Beijing, China
2 Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
3 Department of Neurosurgery, 307 Hospital of PLA, Beijing, China
4 Department of Neurosurgery, Wayne State University, Detroit, MI, USA
5 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
6 Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
Correspondence Address:
Dr. Xunming Ji
Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bc.bc_30_17
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BACKGROUND: Revascularization surgery has been the standard treatment to prevent ischemic stroke in pediatric Moyamoya disease (MMD) patients with ischemic symptoms. However, perioperative complications, such as hyperperfusion syndrome, new infarct on imaging, or ischemic stroke, are inevitable. Remote ischemic conditioning (RIC) is a noninvasive and easy-to-use neuroprotective strategy, and it has potential effects on preventing hyperperfusion syndrome and ischemic infarction.
AIMS: The aim of this study is to investigate the safety and efficacy of RIC in pediatric MMD patients undergoing revascularization surgery.
METHOD: A total of 60 pediatric MMD patients with one or more ischemic symptoms will be recruited and allocated in 1:1 ratio to the RIC group and sham group, respectively. Both RIC and sham RIC will be performed twice daily for 7 consecutive days before revascularization surgery with different cuff pressures during the ischemia period (50 mmHg over-systolic blood pressure and 30 mmHg). Single photon emission computed tomography will be performed within 7 days preoperatively and 3 months postoperatively, respectively, to evaluate the cerebral perfusion status. Other outcomes, including safety, plasma biomarker, functional outcome, and the incidence of infarction and its size, will also be evaluated.
CONCLUSION: This study will provide insights into the preliminary proof of principle, safety, and efficacy of RIC in pediatric MMD patients undergoing revascularization surgery therapy, and this data will provide parameters for future larger scale clinical trials if efficacious.
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