AUTHOR=Xu Jiali , Zhang Qian , Rajah Gary B. , Zhao Wenbo , Wu Fang , Ding Yuchuan , Zhang Bowei , Guo Wenting , Yang Qi , Xing Xiurong , Li Sijie , Ji Xunming 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.811854

DOI=10.3389/fneur.2021.811854

ISSN=1664-2295

ABSTRACT=Background and Purpose: 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 moyamoya disease.
Methods: 34 MMD patients participated in this pilot, prospective randomized controlled study for one year. 18 patients were allocated into 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 multi-delay pseudo-continuous arterial spin labeling and the secondary outcomes were the cumulative incidence of major adverse cerebral events (MACE), the prevalence of stenotic-occlusive progression and periventricular anastomosis at one-year follow-up.
Results: 30 of the 34 MMD patients completed the final follow-up (17 in RIC group and 13 in 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 RIC group and 38.5% in control group (p=0.021). The incidence of MACE was 5.9% in RIC group and 30.8% in control group (hazard ratio with RIC, 0.174; 95% confidence interval, 0.019 to 1.557; P=0.118). No statistical difference was documented in the periventricular anastomosis between two groups after treatment.
Conclusions: RIC has the potential to be a safe and effective adjunctive therapy for MMD patients largely due to improving cerebral blood flow and slowing the arterial progression of the stenotic-occlusive lesions. These findings warrant future study in larger trials.