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Daily Remote Ischemic Conditioning Can Improve Cerebral Perfusion and Slow Arterial Progression of Adult Moyamoya Disease-A Randomized Controlled Study.

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机构: [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. [2]Laboratory of Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China. [3]Department of Neurosurgery, Wayne State University, Detroit, MI, United States. [4]Department of Neurosurgery, Munson Medical Center, Traverse City, MI, United States. [5]Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China. [6]Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. [7]Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China.
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关键词: moyamoya disease stroke remote ischemic conditioning cerebral blood flow arterial spin labeling (ASL)

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Moyamoya disease (MMD) is a complicated cerebrovascular disease with recurrent ischemic or hemorrhagic events. This study aimed to prove the safety and efficacy of remote ischemic conditioning (RIC) on MMD.In total, 34 patients with MMD participated in this pilot, prospective randomized controlled study for 1 year. 18 patients were allocated into the RIC group, and 16 patients accepted routine medical treatment only. RIC-related adverse events were recorded. The primary outcome was the improvement ratio of mean cerebral blood flow (mCBF) in middle cerebral artery territory measured by multidelay pseudocontinuous arterial spin labeling, and the secondary outcomes were the cumulative incidence of major adverse cerebrovascular events (MACEs), the prevalence of stenotic-occlusive progression, and periventricular anastomosis at 1-year follow-up.In total, 30 of the 34 patients with MMD completed the final follow-up (17 in the RIC group and 13 in the control group). No adverse events of RIC were observed. The mCBF improvement ratio of the RIC group was distinctively higher compared with the control group (mCBF-whole-brain : 0.16 ± 0.15 vs. -0.03 ± 0.13, p = 0.001). Stenotic-occlusive progression occurred in 11.8% hemispheres in the RIC group and 38.5% in the control group (p = 0.021). The incidence of MACE was 5.9% in the RIC group and 30.8% in the control group (hazard ratio with RIC, 0.174; 95% CI, 0.019-1.557; p = 0.118). No statistical difference was documented in the periventricular anastomosis between the two groups after treatment.Remote ischemic conditioning has the potential to be a safe and effective adjunctive therapy for patients with MMD largely due to improving cerebral blood flow and slowing the arterial progression of the stenotic-occlusive lesions. These findings warrant future studies in larger trials.Copyright © 2022 Xu, Zhang, Rajah, Zhao, Wu, Ding, Zhang, Guo, Yang, Xing, Li and Ji.

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出版当年[2021]版:
大类 | 3 区 医学
小类 | 3 区 临床神经病学 3 区 神经科学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 临床神经病学 3 区 神经科学
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出版当年[2020]版:
Q2 NEUROSCIENCES Q2 CLINICAL NEUROLOGY
最新[2023]版:
Q2 CLINICAL NEUROLOGY Q3 NEUROSCIENCES

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第一作者机构: [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. [2]Laboratory of Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
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通讯机构: [2]Laboratory of Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China. [6]Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. [7]Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China.
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