Remote Ischemic Conditioning

2017 ◽  
Vol 107 (4) ◽  
pp. 313-317 ◽  
Author(s):  
Jano A. Boghossian ◽  
Bellal Joseph ◽  
Marvin J. Slepian ◽  
David G. Armstrong
Keyword(s):  
Diabetic Foot ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Blood Pressure Cuff ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Pressure Cuff ◽  
Organ Systems

Remote ischemic conditioning involves the use of a blood pressure cuff or similar device to induce brief (3–5 min) episodes of limb ischemia. This, in turn, seems to activate a group of distress signals that has shown the potential ability to improve healing of the heart muscle and other organ systems. Until recently, this has not been tested in people with diabetic foot ulcers. The purpose of this review was to provide background on remote ischemic conditioning and recent data to potentially support its use as an adjunct to healing diabetic foot ulcers and other types of tissue loss. We believe that this inexpensive therapy has the potential to be deployed and incorporated into a variety of other therapies to prime patients for healing and to reduce morbidity in patients with this common, complex, and costly complication.

2256-PUB: Fixed-Ratio Insulin Degludec/Liraglutide (IDegLira) vs. Basal-Bolus Treatment in Type 2 Diabetic (T2DM) Patients with Diabetic Foot Ulcers (DFU) and Critical Limb Ischemia (CLI)

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2256-PUB
Author(s):  
PIERPAOLO FALCETTA ◽  
FRANCESCO S. INDOVINA ◽  
ROSA GIANNARELLI ◽  
ALBERTO PIAGGESI ◽  
GIUSEPPE PENNO ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Fixed Ratio ◽  
Limb Ischemia ◽  
Insulin Degludec ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Basal Bolus ◽  
Type 2 Diabetic

Abstract T P350: Phase I Clinical Feasibility &Safety Trial of Remote Ischemic Conditioning After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mark Connolly ◽  
Joshua Dusick ◽  
Paul Vespa ◽  
Nestor Gonzalez
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Phase I ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Limb Ischemia ◽  
Pain Scale ◽  
End Points ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Pressure Cuff

Objective: Remote ischemic conditioning (RIC) is a phenomenon by which brief periods of sublethal ischemia in one tissue confers protection from ischemia to distant tissues. The safety and feasibility of RIC must be assessed before testing it in efficacy trials. We report a phase I feasibility and safety trial of RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients. Methods: Patients with aSAH received 2-4 RIC sessions on non-consecutive days. A complete session was defined as four rounds of 5 minutes of one sided lower limb ischemia with a thigh blood pressure cuff followed by 5 minutes of reperfusion (verified by pedal Doppler). Primary end-points were tolerance to the procedure and any complication attributable to RIC. Secondary end-points included cerebral infarction or hemorrhage. Results: Twenty-one patients (67% female, mean age 52, Fisher 3.5, H&H 3.3) were enrolled. Seventeen had evidence of vasospasm during hospitalization. Of 76 RIC sessions performed, 75 (98.7%) were completed and tolerated. One session was incomplete due to poor cooperation secondary to delirium. No patients developed DVTs or other local complications within 2 weeks of their final RIC session. No patients suffered cerebral infarction or hemorrhage throughout the duration of RIC sessions and through 72 hours after their last complete session. Three had infarction confirmed on MRI at 3 and 5 days following the final RIC session. In conscious patients, there was a small increase in the analog pain scale upon inflation of the cuff (deflated: 0.5 inflated: 1.2, p<0.0005), but none requested to stop the session. There was no significant change in other vitals. Conclusions: In aSAH patients, RIC was successfully applied and well tolerated with no procedure-related complications. No patient suffered ischemic stroke within 72 hours of RIC, consistent with our previous studies showing protective cerebral metabolic changes up to 48 hours after sessions. These results demonstrate that application of RIC is safe and feasible and suggest that RIC may be associated with transient tolerance to ischemia during the treatment period. The efficacy of RIC for neuroprotection should be investigated in larger controlled trials.

scholarly journals PEDIS Score Analysis in Diabetic Foot Ulcer following Angioplasty Revascularization Procedure

2021 ◽  
Vol 2 (1) ◽  
pp. 20-25
Author(s):  
Ridho Sinaga ◽  
Djony Tjandra ◽  
Richard Sumangkut ◽  
Billy Karundeng ◽  
Fima Langi
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Tissue Loss ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Vascular Disorders ◽  
Score Analysis ◽  
Before And After ◽  
Artery Disease

Background: Diabetic foot ulcers (DFU) is one of the major health care problems. Diabetic foot ulcers are a combination of vascular and non-vascular disorders. Vascular disorders that occur in the form of diabetic angiopathy which can be in the form of macro angiopathy if the condition occurs in large blood vessels, and micro angiopathy if it occurs in arterioles and capillaries. Revascularization can be done minimally invasive and has become the gold standard in the management of chronic limb ischemic (CLI). WHO recommends Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) classification to diagnose and to determine the management of diabetic foot. We conduct a study to find out whether there are improvements in the PEDIS score of diabetic foot ulcer patients post angioplasty Methods: This study was designed in the form of a quasi-experiment, in which measurements before and after treatment were carried out on patients with diabetic foot ulcers (DFU) who underwent revascularization angioplasty without any measurement for control patients. From November 2019 to September 2020, there were 48 cases of diabetic foot ulcer with peripheral artery disease (PAD) who underwent angioplasty. Before the procedure, a clinical evaluation and calculation of the PEDIS score were carried out then angioplasty was performed, after the procedure the PEDIS score was calculated and evaluated in the first, second and third weeks. Results: The PEDIS scores of the patients prior to angioplasty had a median score of 8 (IQR 7; 9). Post-procedure the median quantity fell to 6 on both the immediate post angioplasty and two weeks afterward measurement with the width of the IQR narrowing slightly at the last measurement. The male patients’ PEDIS scores did not differ relatively from those of the female patients at the three measurement times, and their scores were almost identical to the scores for the patients as a whole. Conclusion: The results of this study indicate that there is an improvement in the PEDIS score in diabetic foot ulcer patients after revascularization angioplasty.

P2589Platelets serve as carriers of cardioprotective factors after remote ischemic conditioning in humans

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H R Lieder ◽  
M Tsoumani ◽  
I Andreadou ◽  
G Heusch ◽  
P Kleinbongard
Keyword(s):  
Blood Pressure ◽  
Infarct Size ◽  
Healthy Volunteers ◽  
Blood Cells ◽  
Blood Pressure Cuff ◽  
Signal Transfer ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Pressure Cuff ◽  
Platelet Releasate

Abstract Background/Introduction Brief episodes of ischemia/reperfusion (I/R) in a tissue or organ remote from the heart reduce myocardial infarct size after sustained severe myocardial I/R in all species tested so far, including humans. Remote ischemic conditioning can be induced before (pre-), during (per-) or following (post-) myocardial ischemia. Signal transfer from the remote tissue/organ to the heart is both, neuronal and humoral. Humoral signal transfer has been evidenced by the transfer of cardioprotection via plasma or plasma derivatives from one individual to another individual's heart, even across species. Circulating blood cells have been considered as targets for cardioprotection, but so far not as carriers of cardioprotective signals. Purpose To investigate the role of platelets as potential carriers of cardioprotection by remote ischemic preconditioning (RIPC). Methods Peripheral venous blood samples were collected from healthy volunteers (5 male/5 female, mean age 26±5 years) before and 60 min after RIPC (3×5 min blood pressure cuff inflation at 200 mmHg on the left upper arm/5 min deflation) or placebo (PLA) protocol (blood pressure cuff uninflated). RIPC and PLA protocols, respectively, were performed in randomized sequence at an interval of one week. Blood (80 mL) was drawn into tubes containing sodium citrate, apyrase and prostaglandin E1. Blood cells were counted using a hematology analyzer. Blood was centrifuged (100 g, 15 min, at room temperature) to obtain platelet-rich plasma (PRP). PRP was washed twice with buffer (pH 6.5), and the pellet was re-suspended in suspension buffer (pH 7.35); the platelet amount was adjusted to 2.5x103 platelets/μL. The platelet suspension was supplemented with 1 mol/L CaCl2 and centrifuged (14,000 g) at 4°C for degranulation. The supernatant, i.e. the platelet releasate, was retrieved. Male Lewis rats were sacrificed, their hearts isolated and perfused at constant pressure. Diluted platelet releasate (1:10) was infused into the isolated perfused rat hearts for 8 min followed by 2 min washout before 30/120 min global I/R. Infarct size (percentage of ventricular mass) was demarcated with staining by triphenyltetrazolium chloride. Data are presented as mean±SD. Results The platelet count was increased after RIPC, but unchanged after PLA (RIPC: from 204±19x103 platelets/μL to 247±16x103 platelets/μL; PLA: from 230±16x103 cells/μL to 222±18x103 platelets/μL; PLA vs. RIPC p<0.01, RIPC before vs. after p<0.01, two-way ANOVA for repeated measures with Fisher's least significant differences post-hoc tests), whereas all other blood cell counts remained unchanged. Infarct size was less with infusion of platelet releasate after RIPC in comparison to platelet releasate before RIPC and to platelet releasate before and after PLA, respectively (see Figure). Conclusion In response to RIPC in healthy volunteers, platelets carry soluble cardioprotective factor(s). Their precise nature must still be identified.

Remote Ischemic Conditioning

2017 ◽  
Vol 22 (5) ◽  
pp. 404-407 ◽  
Author(s):  
Vera Belaoussoff ◽  
Rocky Ganske ◽  
Andrew Redington
Keyword(s):  
Blood Pressure ◽  
Large Scale ◽  
Randomized Trials ◽  
Blood Pressure Cuff ◽  
Phase 3 ◽  
Remote Ischemic Conditioning ◽  
Pivotal Point ◽  
Ischemic Conditioning ◽  
Pressure Cuff

Remote ischemic conditioning (RIC) is at a pivotal point in its evolution, both in terms of its adoption as a therapy and its viability commercially. The most usual way of inducing RIC, with a standard blood pressure cuff and a stopwatch, is time-consuming and potentially inaccurate and unsafe. Development of automated devices have facilitated large-scale randomized trials and will make clinical deployment of the technique more straightforward. Both the medical and commercial future of RIC will depend on the results of upcoming phase 3 pivotal trials.

Microparticle release in remote ischemic conditioning mechanism

2012 ◽  
Vol 303 (7) ◽  
pp. H871-H877 ◽  
Author(s):  
Julien Jeanneteau ◽  
Pierre Hibert ◽  
Maria Carmen Martinez ◽  
Simon Tual-Chalot ◽  
Sophie Tamareille ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Annexin V ◽  
Limb Ischemia ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Healthy Humans ◽  
Biological Vector ◽  
Pressure Cuff ◽  
Circulating Microparticles

Remote ischemic conditioning (RCond) induced by short periods of ischemia and reperfusion of an organ or tissue before myocardial reperfusion is an attractive strategy of cardioprotection in the context of acute myocardial infarction. Nonetheless, its mechanism remains unknown. A humoral factor appears to be involved, although its identity is currently unknown. We hypothesized that the circulating microparticles (MPs) are the link between the remote tissue and the heart. MPs from rats and healthy humans undergoing RCond were characterized. In rats, RCond was induced by 10 min of limb ischemia. In humans, RCond was induced by three cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff. In the second part of the study, rats underwent 40 min myocardial ischemia followed by 2 h reperfusion. Infarct size was measured and compared among three groups of rats: 1) myocardial infarction alone (MI) ( n = 6); 2) MI + RCond started 20 min after coronary ligation ( n = 6); and 3) MI + injection of RCond-derived rat MPs (MI + MPs) ( n = 5). MPs from endothelial cells (CD54+ and CD146+ for rats and humans, respectively) and procoagulant MPs (Annexin V+) markedly increased after RCond, both in rats and humans. RCond reduced infarct size (24.4 ± 5.9% in MI + RCond vs. 54.6 ± 4.7% in MI alone; P < 0.01). Infarct size did not decrease in MI + MPs compared with MI alone (50.2 ± 6.4% vs. 54.6 ± 4.7%, not significantly different). RCond increased endothelium-derived and procoagulant MPs in both rats and humans. However, MP release did not appear to be a biological vector of RCond in our model.

scholarly journals Recurrence of Critical Limb Ischemia After Endovascular Intervention in Patients with Diabetic Foot Ulcers

2018 ◽  
Vol 7 (6) ◽  
pp. 171-176 ◽  
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Costantino Del Giudice ◽  
Valerio Da Ros ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Limb Ischemia ◽  
Endovascular Intervention ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers

scholarly journals Hyperglycemia Increases Susceptibility to Ischemic Necrosis

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
D. Lévigne ◽  
M. Tobalem ◽  
A. Modarressi ◽  
B. Pittet-Cuénod
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Limb Ischemia ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Tissue Necrosis ◽  
Doppler Flowmetry ◽  
Per Se ◽  
Underlying Mechanisms

Diabetic patients are at risk for spontaneous foot ulcers, chronic wounds, infections, and tissue necrosis. Current theories suggest that the development and progression of diabetic foot ulcers are mainly caused by arteriosclerosis and peripheral neuropathy. Tissue necrosis plays a primordial role in the progression of diabetic foot ulcers but the underlying mechanisms are poorly understood. The aim of the present study was to investigate the effects of hyperglycemiaper seon the susceptibility of ischemic tissue to necrosis, using a critical ischemic hind limb animal model. We inflicted the same degree of ischemia in both euglycemic and streptozotocin-induced hyperglycemic rats by resecting the external iliac, the femoral, and the saphenous arteries. Postoperative laser Doppler flowmetry of the ischemic feet showed the same degree of reduction in skin perfusion in both hyperglycemic and euglycemic animals. Nevertheless, we found a significantly higher rate of limb necrosis in hyperglycemic rats compared to euglycemic rats (71% versus 29%, resp.). In this study, we revealed that hyperglycemiaper seincreases the susceptibility to limb necrosis in ischemic conditions. Our results may help to better understand the physiopathology of progressive diabetic wounds and underline the importance of strict glycemic control in patients with critical limb ischemia.

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