Effect of Remote Ischemic Conditioning on the Form and Function of Red Blood Cells in Patients with Acute Ischemic Stroke

Rolf Ankerlund Blauenfeldt*, Jennifer Waller, Kim Ryun Drasbek, Jesper Nørgaard Bech, Anne Mette Hvas, Julie Brogaard Larsen, Morten Nørgaard Andersen, Marlene Christina Nielsen, Maria Kjølhede, Mathilde Kjeldsen, Martin Faurholdt Gude, Mohammad Badruzzaman Khan, Babak Baban, Grethe Andersen, David Charles Hess

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

BACKGROUND: Remote ischemic conditioning (RIC) is a simple and low-cost intervention that is thought to increase collateral blood flow through the vasodilatory effects of nitric oxide (NO) produced by the endothelium and red blood cells (RBCs). This study aims to investigate whether RIC affects RBC deformability and levels of NO and nitrite in patients with ischemic stroke. METHODS: This is a predefined substudy to the RESIST (Remote Ischemic Conditioning in Patients With Acute Stroke Trial) randomized clinical trial conducted in Denmark. RIC was started in the ambulance and continued at the hospital for seven days. Blood samples were collected at different time points: prehospital in the ambulance, in-hospital upon arrival, 2 hours postadmission, and 24 hours postadmission. RBC deformability and erythrocyte aggregation rate were assessed using ektacytometry, NO using flowcytometry, and nitrite content using ozone chemiluminescence. RESULTS: Of 1500 prehospital randomized patients, 486 patients were included in this study between July 28, 2020, and November 11, 2023, and had blood samples taken. Of these, 249 (51%) had AIS, and here RIC treatment was not associated with increased RBC maximal deformability (RIC, 0.549; sham, 0.548; P=0.31), RBC NO (RIC, 35 301 median fluorescence intensity; sham, 34979 median fluorescence intensity; P=0.89), or nitrite (RIC, 0.036 µmol/L; sham, 0.034 µmol/L; P=0.38), but RIC treatment was associated with a significantly reduced aggregation pressure and a slower erythrocyte aggregation rate (RIC, 323.76 millipascal; sham, 352.74 millipascal; P=0.0113). CONCLUSIONS: Prehospital and in-hospital RIC significantly reduced erythrocyte aggregation rate in patients with acute ischemic stroke, while there was no change in RBC deformability, NO content, or whole blood nitrite levels.

Original languageEnglish
JournalStroke
Volume56
Issue3
Pages (from-to)603-612
Number of pages10
ISSN0039-2499
DOIs
Publication statusPublished - 1 Mar 2025

Keywords

  • erythrocytes
  • ischemic stroke
  • nitric oxide
  • nitrites

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