Ji, Xunming

Abstract: AIM: The purpose of this study is to investigate the safety and effectiveness of remote ischemic conditioning (RIC) as a therapeutic intervention for cerebral ischemia in patients with Takayasu arteritis (TA). METHODS: TARIC-1 is a randomized, double-blind, parallel-group pilot trial conducted at Xuanwu Hospital, Capital Medical University. Participants with TA and reduced cerebral blood perfusion are randomly allocated to either the RIC or sham-RIC groups. Both the groups receive conventional medical care, with the RIC group receiving twice-daily sessions of 200 mmHg inflation pressure and the sham-RIC group receiving 60 mmHg inflation pressure, for 24 consecutive weeks. OUTCOMES: The primary outcome is the change in mean cerebral blood flow across the entire brain and regions of interest following the 24-week RIC treatment. Secondary outcomes include clinical assessments using the Indian Takayasu Clinical Activity Score 2010, Vasculitis Damage Index, and Birmingham Vasculitis Activity Score at 24 weeks postintervention. Changes in arterial transit time and the incidence of major adverse cerebrovascular events are additional secondary outcomes. Safety outcomes include mortality and any adverse events, including skin changes and pain ratings, within the 24-week period. SAMPLE SIZE ESTIMATES: This pilot study plans to enroll 22 patients per group, totaling 44 participants. CONCLUSIONS: In individuals with TA, RIC may be a well-tolerated treatment that enhances cerebral perfusion and lowers the risk of ischemic cerebrovascular episodes. TRIAL REGISTRATION: http://www.clinicaltrials.gov (identifier: NCT06178419).

Abstract: Stroke remains a leading cause of global mortality and is projected to become the second-largest contributor to the global disease burden by the year 2050. Despite advancements in medical technology, a definitive cure for stroke is still unavailable, and effective management heavily depends on timely intervention after its occurrence. In recent decades, stroke incidence has declined in developed nations due to improved preventive measures while it has surged in developing regions, particularly among younger populations. This highlights the urgent need for comprehensive prevention strategies to address modifiable factors and reduce long-term disabilities. This review categorizes modifiable stroke risk factors into three key domains: metabolic, behavioral, and environmental. It synthesizes current knowledge and evaluates intervention strategies targeting hypertension, diabetes, smoking, dietary habits, and air pollution, among others. The review also examines emerging evidence on the benefits and limitations of these interventions, providing critical insights into their effectiveness. Notably, the discussion also encompasses the interplay and combined impacts of these risk factors, offering a thorough insight into etiology and emphasizing the importance of adopting a comprehensive strategy for risk management. By providing a general view of stroke prevention efforts, the paper aims to guide future research and support the development of evidence-based, population-level strategies to mitigate stroke risk globally.