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

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

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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.

Asymptomatic moyamoya diseaseChildrenRemote ischemic conditioningStroke

Shuang-Feng Huang、Jia-Li Xu、Chang-Hong Ren、Nathan Sim、Cong Han、Yi-Qin Han、Wen-Bo Zhao、Yu-Chuan Ding、Xun-Ming Ji、Si-Jie Li

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Department of Neurology,Xuanwu Hospital,Capital Medical University,NO.45 Changchun Street,Xicheng District,Beijing 100053,China

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

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

Department of Neurosurgery,Wayne State University,Detroit,MI,USA

Department of Neurosurgery,The Fifth Medical Centre,Chinese PLA General Hospital,Beijing,China

Department of Emergency,Xuanwu Hospital,Capital Medical University,Beijing,China

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National Natural Science Foundation of ChinaNational Natural Science Foundation of ChinaNational Natural Science Foundation of ChinaNational Key R & D Program of ChinaBeijing Natural Science Foundation

8237130582001257822744012022YFC2408800JQ22020

2024

10.1007/s12519-024-00824-z

世界儿科杂志(英文版)

世界儿科杂志(英文版)

CSTPCD
ISSN：
年,卷(期)：2024.20(9)