Objective  Based on the effect of remote ischemic preconditioning on cerebral circulation time in patients with severe carotid artery stenosis (RIC-CCT) trial, we aimed to investigate the impact of a history of stroke/TIA on the efficacy of remote ischemic preconditioning (RIC) in improving the cerebral circulation time on the stenotic side (sCCT) in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).
Methods  We conducted a post hoc analysis of the RIC-CCT trial. Patients were divided into two groups according to the presence or absence of prior stroke/TIA: the no prior stroke/TIA group and the prior stroke/TIA group. Within each group, patients were further assigned to the RIC group or the control group. The primary outcome was the change in sCCT from pre-RIC period to precarotid artery stenting. The secondary outcome was the incidence of contrast staining on brain CT at 1 hour after carotid artery stenting. Linear regression and binary logistic regression were used to assess the effect of RIC in each group, and interaction analysis was performed to evaluate whether prior stroke/TIA history modified the efficacy of RIC.
Results  A total of 122 patients with sICAS were included, comprising 69 patients in the no prior stroke/TIA group and 53 patients in the prior stroke/TIA group. In the no prior stroke/TIA group, improvement in sCCT was significantly greater in the RIC group than in the control group [(0.54±0.39) vs. (0.01±0.10), adjusted β=0.52, 95%CI 0.38-0.66, adjusted P<0.001]. In the prior stroke/TIA group, improvement in sCCT was also significantly greater in the RIC group than in the control group [(0.73±0.53) vs. (0.02±0.10), adjusted β=0.69, 95%CI 0.45-0.93, adjusted P<0.001]. Interaction analysis showed no significant interaction between prior stroke/TIA history and the efficacy of RIC on sCCT improvement. RIC showed a trend toward reduced contrast staining on CT in no prior stroke/TIA group and the prior stroke/TIA group, but the differences were not statistically significant.
Conclusions  Shortterm RIC significantly improves sCCT in patients with sICAS, regardless of the presence or absence of a prior history of stroke or TIA.

Key words: Remote ischemic preconditioning; Carotid artery stenosis; Cerebral circulation time; Ischemic stroke; Transient ischemic attack

摘要： 目的 基于远隔缺血预适应对重度颈动脉狭窄患者脑循环时间的影响（the effect of remote ischemic preconditioning on cerebral circulation time in patients with severe carotid artery stenosis，RIC-CCT）研究，探讨卒中/TIA史对远隔缺血预适应（remote ischemic preconditioning，RIC）改善重度颈内动脉狭窄（severe internal carotid artery stenosis，sICAS）患者狭窄侧脑循环时间（cerebral circulation time of the stenosis side，sCCT）疗效的影响。
方法 本研究为RIC-CCT研究的事后分析。根据有无卒中/TIA病史，将患者分为卒中/TIA组和无卒中/TIA组；每组进一步分为RIC组和对照组。主要结局为sCCT从接受RIC前至颈动脉支架置入术前的变化；次要结局为颈动脉支架置入术后1 h造影剂渗出的发生率。采用线性回归和二元logistic回归评估RIC在每个组中的疗效；通过交互作用分析卒中/TIA史对RIC疗效的影响。
结果 共纳入122例sICAS患者，其中无卒中/TIA组69例，卒中/TIA组53例。无卒中/TIA组中，RIC组sCCT改善显著优于对照组［（0.54±0.39）vs.（（0.01±0.10)，校正β=0.52，95%CI 0.38～0.66，校正P<0.001］；在卒中/TIA组中，RIC组sCCT改善同样显著优于对照组［（0.73±0.53）vs.（0.02±0.10），校正β=0.69，95%CI 0.45～0.93，校正P<0.001）］。交互作用分析显示，卒中/TIA病史与RIC改善sCCT的疗效之间无显著交互作用。无卒中/TIA组和卒中/TIA组中，RIC均有降低CT造影剂渗出发生率的趋势，但差异均无统计学意义。
结论 无论是否存在卒中/TIA史，短期RIC均可显著改善sICAS患者的sCCT。

关键词: 远隔缺血预适应; 颈动脉狭窄; 脑循环时间; 缺血性卒中; 短暂性脑缺血发作

CLC Number: 

• R74