%0 Journal Article
%T Clinical Applications of Remote Ischemic Preconditioning
%A Kristin Veighey
%A Raymond J. MacAllister
%J Cardiology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/620681
%X Ischemia-reperfusion injury is a composite of damage accumulated during reduced perfusion of an organ or tissue and the additional insult sustained during reperfusion. Such injury occurs in a wide variety of clinically important syndromes, such as ischemic heart disease and stroke, which are responsible for a high degree of morbidity and mortality worldwide. Basic research has identified a number of interventions that stimulate innate resistance of tissues to ischemia-reperfusion injury. Here, we summarise the experimental and clinical trial data underpinning one of these ¡°conditioning¡± strategies, the phenomenon of remote ischemic preconditioning. 1. Introduction Ischemia-reperfusion injury underpins the damage of myocardial infarction, stroke, and other conditions complicated by interruption of the blood supply to tissues. Strategies to limit the duration of ischemia have achieved substantial health gains in myocardial infarction and, to a lesser degree, stroke. However door-to-needle times have probably reached the minimum that is possible in many health-care delivery systems, so further reduction in morbidity and mortality from IR injury will require strategies to increase tissue tolerance to ischemia or reduce damage that occurs on reperfusion. One such approach is ischemic preconditioning, and its variant remote ischemic preconditioning, the subject of this paper. 2. Types of Ischemic Preconditioning Ischemic preconditioning (IPC) describes the phenomenon whereby transient, brief periods of ischemia confer protection against a subsequent prolonged and injurious period of ischemia. There are a number of ways in which preconditioning can be induced. Local preconditioning occurs when the preconditioning stimulus is applied to the same organ or tissue that will subsequently sustain the ischemic injury. Remote ischemic preconditioning refers to a stimulus applied to a distant organ or tissue, which then protects against index ischemia. For example, the preconditioning stimulus might be suprasystolic blood pressure inflations on an arm or leg, which then confer myocardial protection against subsequent ischemia. Postconditioning occurs when there is staged reperfusion, for example, in the setting of balloon angioplasty. Its variant perconditioning occurs when the conditioning stimulus is applied during ischemia. 3. Ischemic Preconditioning Ischemic preconditioning was first described in 1986, when Murry et al. demonstrated that in the dog, brief episodes of ischemia (4 cycles of 5-minute occlusion followed by reperfusion) of the circumflex artery reduced
%U http://www.hindawi.com/journals/crp/2012/620681/