Abstract W P244: Effect of Remote Limb Ischemic Conditioning on CBF as Measured by Arterial Spin Labeling in Human Stroke
Background: Remote limb ischemic conditioning (RLIC) is a promising treatment for ischemic stroke. We have previously shown that RLIC increases cerebral blood flow, reduces infarct size, and improves outcome in a murine thromboembolic stroke model (Hoda N et al. Stroke. 2012; 43:2794). We hypothesized that RLIC will increase CBF in hypoperfused areas in acute stroke patients as detected by MRI Arterial Spin Labeling (ASL)
Methods: Patients with an acute ischemic stroke within 14 days and with a persistent mismatch defined by a perfusion defect measured by ASL that was at least 20% larger than the area of infarction as measured by diffusion weighted imaging (DWI) were eligible. Patients underwent 4 cycles of blood pressure cuff inflation (x200 mm Hg) for 5 minutes and deflation for 5 minutes on the leg or arm, 1- 2 times per day. MRI ASL, DWI, and 3D T1-weighted Fast Spoiled Gradient-Echo (FSPGR) images were taken before and 60 minutes after the last cycle of RLIC to measure CBF. Two neuroradiologists analyzed the images.
Results: After 3 of 4 RLIC sessions, the CBF improved and the mismatch decreased by at least 15%. In the one patient without a reduction in mismatch, the RLIC was performed on the arm and not the leg.
Conclusions: 1.) RLIC increased CBF as measured by ASL in stroke patients with a persistent diffusion-perfusion mismatch. 2.) Since it can be repeated multiple times on the same patient, ASL may be a useful biomarker of the conditioning response in humans. 3.) Further work in a larger sample of patients is needed to define the optimal regimen of RLIC and to determine the utility of ASL as a biomarker.
Author Disclosures: F.S. Andersen: None. S. Forseen: None. N. Yanasak: None. B.C. Gilbert: None. J.A. Switzer: Consultant/Advisory Board; Modest; REACH Health, Inc.. Research Grant; Significant; Research grants for Genentech on Telestroke Networks. Other; Significant; Georgia Regents Medical Center employs Dr Switzer and the hospital provides contracted telehealth services to hospitals in Georgia and South Carolina for telestroke. F.T. Nichols: None. A. Bruno: None. S. Jacob: None. B. Close: None. A. Kim: None. N. Hoda: None. D.C. Hess: None.
This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate – Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico, Tennessee, U.S. Virgin Islands.
- © 2014 by American Heart Association, Inc.