Remote ischemic conditioning prevents ischemic cerebrovascular events in children with moyamoya disease:a randomized controlled trial

Shuang-Feng Huang ¹Jia-Li Xu ²Chang-Hong Ren ³Nathan Sim ⁴Cong Han ⁵Yi-Qin Han ⁵Wen-Bo Zhao ¹Yu-Chuan Ding ⁴Xun-Ming Ji ³Si-Jie Li⁶

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作者信息

1. Department of Neurology,Xuanwu Hospital,Capital Medical University,NO.45 Changchun Street,Xicheng District,Beijing 100053,China
2. Department of Neurology,Xuanwu Hospital,Capital Medical University,No 45,Changchun Street,Xicheng District,Beijing 100053,China;Department of Rehabilitation Medicine,Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing,China
3. Beijing Institute of Brain Disorders,Capital Medical University,No.10,Xitoutiao,You'anmenwai,Fengtai District,Beijing 100053,China;Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine,Xuanwu Hospital,Capital Medical University,Beijing,China
4. Department of Neurosurgery,Wayne State University,Detroit,MI,USA
5. Department of Neurosurgery,The Fifth Medical Centre,Chinese PLA General Hospital,Beijing,China
6. Department of Neurology,Xuanwu Hospital,Capital Medical University,No 45,Changchun Street,Xicheng District,Beijing 100053,China;Beijing Institute of Brain Disorders,Capital Medical University,No.10,Xitoutiao,You'anmenwai,Fengtai District,Beijing 100053,China;Department of Emergency,Xuanwu Hospital,Capital Medical University,Beijing,China
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Abstract

Background Moyamoya disease(MMD)is a significant cause of childhood stroke and transient ischemic attacks(TIAs).This study aimed to assess the safety and efficacy of remote ischemic conditioning(RIC)in children with MMD.Methods In a single-center pilot study,46 MMD patients aged 4 to 14 years,with no history of reconstructive surgery,were randomly assigned to receive either RIC or sham RIC treatment twice daily for a year.The primary outcome measured was the cumulative incidence of major adverse cerebrovascular events(MACEs).Secondary outcomes included ischemic stroke,recurrent TIA,hemorrhagic stroke,revascularization rates,and clinical improvement assessed using the patient global impres-sion of change(PGIC)scale during follow-up.RIC-related adverse events were also recorded,and cerebral hemodynamics were evaluated using transcranial Doppler.Results All 46 patients completed the final follow-up(23 each in the RIC and sham RIC groups).No severe adverse events associated with RIC were observed.Kaplan-Meier analysis indicated a significant reduction in MACEs frequency after RIC treatment[log-rank test(Mantel-Cox),P=0.021].At 3-year follow-up,two(4.35％)patients had an ischemic stroke,four(8.70％)experienced TIAs,and two(4.35％)underwent revascularization as the qualifying MACEs.The clinical improve-ment rate in the RIC group was higher than the sham RIC group on the PGIC scale(65.2％vs.26.1％,P＜0.01).No statistical difference in cerebral hemodynamics post-treatment was observed.Conclusions RIC is a safe and effective adjunct therapy for asymptomatic children with MMD.This was largely due to the reduced incidence of ischemic cerebrovascular events.

Key words

Asymptomatic moyamoya disease/Children/Remote ischemic conditioning/Stroke

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基金项目

National Natural Science Foundation of China(82371305)

National Natural Science Foundation of China(82001257)

National Natural Science Foundation of China(82274401)

National Key R & D Program of China(2022YFC2408800)

Beijing Natural Science Foundation(JQ22020)

出版年

2024

世界儿科杂志(英文版)

CSTPCD

ISSN：

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