Testing of a System for Remote Ischemic Conditioning in Cerebral Small Vessel Disease and Pre-hospital Stroke Care

Launched by UNIVERSITY OF CALGARY · Jul 21, 2023

Keywords

ClinConnect Summary

Cerebral Small Vessel Disease (CSVD) causes 20-25% of strokes and is the most common cause of Vascular Cognitive Impairment (VCI). Patients with CSVD accumulate frequent, small brain infarcts, leading to accelerated functional and cognitive decline, but at present, there are no approved disease-modifying treatments. The prehospital setting of ischemic stroke care is another challenge. Many patients incur prehospital delays in their arrival to stroke centres, and in countries like Canada, patients often require an hour or more to be transported to hospital even under the best of circumstance...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• * For patients with Cerebral Small Vessel Disease (CSVD):
• • 1. Age ≥18 years
• • 2. Evidence of CSVD, defined as (a) beginning confluent white-matter changes (Age-Related White Matter Changes grade 2) on any slice on CT/MRI Brain(21) OR (b) ≥2 supratentorial subcortical infarcts
• • 3. Either (a) cognitive complaints from the patient or family member OR (b) history of small vessel ischemic stroke with corresponding evidence of brain infarct on CT or MRI that is attributed by the treating physician to CSVD
• * For patients with ischemic stroke:
• • 1. Age ≥18 years
• • 2. Evaluated in the Mobile Stroke Unit
• • 3. Diagnosed as having an acute ischemic stroke (all MSU code stroke activations during the study will be tracked)
• Exclusion Criteria:
• * For patients with CSVD:
• • 1. Unable to converse meaningfully (severe dementia or post-stroke deficit)
• • 2. No phone access for study monitoring and follow-up (either cell or landline)
• • 3. Therapeutic anticoagulation or other bleeding diathesis posing an unacceptable risk in physician's opinion (antiplatelet therapy is permitted)
• • 4. Any vascular, soft-tissue, or orthopedic injury that in the physician's opinion contraindicates arm ischemic preconditioning
• • 5. History of peripheral vascular disease, such as subclavian or other upper limb arterial stenosis or occlusion
• * For patients with ischemic stroke:
• • 1. Unable to give consent or assent by proxy (written or recorded by MSU audio-video)
• • 2. Therapeutic anticoagulation or other bleeding diathesis as with CSVD above
• • 3. Any vascular, soft-tissue, or orthopedic injury that in the physician's opinion contraindicates arm ischemic preconditioning
• • 4. History of peripheral vascular disease, such as subclavian or other upper limb arterial stenosis or occlusion