Remote Ischaemic Conditioning after Stroke Trial (RECAST): a pilot randomised placebo controlled phase II trial in acute ischaemic stroke (ISRCTN 86672015)

England, Timothy J. and Hedstrom, Amanda and O'Sullivan, Saoirse and Donnelly, Richard and Barrett, David A. and Sarmad, Sarir and Sprigg, Nikola and Bath, Philip M.W. (2017) Remote Ischaemic Conditioning after Stroke Trial (RECAST): a pilot randomised placebo controlled phase II trial in acute ischaemic stroke (ISRCTN 86672015). Stroke, 48 (3). ISSN 1524-4628

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Abstract

Background:

Repeated episodes of limb ischaemia and reperfusion (remote ischaemic conditioning, RIC) may improve outcome after acute stroke.

Methods:

We performed a pilot blinded placebo-controlled trial in patients with acute ischaemic stroke, randomised 1:1 to receive four cycles of RIC within 24 hours of ictus. The primary outcome was tolerability and feasibility. Secondary outcomes included safety, clinical efficacy (day 90), putative biomarkers (pre- and post intervention, day 4) and exploratory haemodynamic measures.

Findings:

Twenty-six patients (13 RIC, 13 sham) were recruited 15.8 hours (SD 6.2) post onset, age 76·2 years (10.5), blood pressure 159/83mmHg (25/11) and NIHSS 5 [IQR 3.75-9.25]. RIC was well tolerated with 49/52 cycles completed in full. Three patients experienced vascular events in the sham group: two ischaemic strokes and two myocardial infarcts versus none in the RIC group (p=0·076, log-rank test). Compared to sham, there was a significant decrease in day 90 NIHSS in the RIC group, median NIHSS 1 [0.5-5] versus 3 [2-9.5], p=0.04; RIC augmented plasma heat shock protein (HSP) 27 (p<0·05, repeated 2-way ANOVA) and phosphorylated HSP27 (p<0·001) but not plasma S100-beta, matrix metalloprotinase-9, endocannabinoids or arterial compliance.

Conclusions:

RIC after acute stroke is well tolerated and appears safe and feasible. RIC may improve neurological outcome and protective mechanisms may be mediated through HSP27. A larger trial is warranted.

Clinical Trial Registration-URL: http://www.isrctn.com. Unique identifier: ISRCTN86672015

Item Type: Article
Keywords: stroke, post-conditioning, biomarker
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine
University of Nottingham, UK > Faculty of Science > School of Pharmacy
Identification Number: 10.1161/STROKEAHA.116.016429
Depositing User: Eprints, Support
Date Deposited: 19 Jan 2017 09:45
Last Modified: 17 Mar 2017 09:10
URI: http://eprints.nottingham.ac.uk/id/eprint/39949

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