Abstract
Stroke is a leading cause of death and disability. Intravenous thrombolysis and mechanical
thrombectomy have greatly improved outcomes in acute ischemic stroke (AIS). However,
only a minority of patients receive reperfusion therapies, highlighting the need for
novel neuroprotective therapies. Remote ischemic conditioning (RIC), consisting of
brief, intermittent extremity occlusion and reperfusion induced with an inflatable
cuff, is a potential neuroprotective therapy in acute stroke. The objective of this
narrative review is to describe the effect of RIC on endogenous fibrinolysis and,
from this perspective, investigate the potential of RIC in the prevention and treatment
of stroke. A systematic literature search was performed in PubMed, and human studies
in English were included. Seven studies had investigated the effect of RIC on fibrinolysis
in humans. Long-term daily administration of RIC increased endogenous fibrinolysis,
whereas a single RIC treatment did not acutely influence endogenous fibrinolysis.
Fifteen studies had investigated the effect of RIC as a neuroprotective therapy in
the prevention and treatment of stroke. Long-term RIC administration proved effective
in reducing new cerebral vascular lesions in patients with established cerebrovascular
disease. In patients with acute stroke, RIC was safe and feasible, though its clinical
efficacy as a neuroprotectant is yet unproven. In conclusion, a single RIC treatment
does not affect fibrinolysis in the acute phase, whereas long-term RIC administration
may increase endogenous fibrinolysis. Increased endogenous fibrinolysis is unlikely
to be the mediator of the acute neuroprotective effect of RIC in stroke patients,
whereas it may partly explain the reduced stroke recurrence associated with long-term
RIC treatment.
Keywords
fibrinolysis - ischemic preconditioning - stroke - cerebral hemorrhage - intracranial
arteriosclerosis
