Protective effect of remote ischemic preconditioning on blood pressure control in magnetic resonance-guided focused ultrasound operations

Backrgound. Magnetic resonance-guided focused ultrasound (MR-FUS) is a new non-invasive technology for the surgical treatment of extrapyramidal movement disorders for such pathologies as essential tremor, Parkinson’s disease, etc. In these cases, the brain is injured and a zone of ischemia is formed. Arterial hypertension (AH) is one of the most common pathologies, which is often accompanied by neurological diseases. Objective. To investigate the effect of the remote ischemic preconditioning (RIPC) on blood pressure (BP) during MR-FUS surgery. Design – blinded, randomized, controlled, 2-group study with sham preconditioning. Materials and Methods. Patients were randomized into the RIPC group (cuff systolic BP (SBP) >50 mmHg, n=42) and the group with sham RIPC (cuff diastolic BP (DBP), n=39) before surgery in regime 3 cycles each 5 min with 5 min rest between cycles. Results. While there was a decrease in SBP and DBP before and after the operation in the RIPC group, there was an increase (p<0.001) in the sham RIPC group. Using the Difference-in-Difference equation for SBP, SBP was 8.9 (5.9–11.9) mm Hg higher in the sham RIPC group than in the RIPC group (p<0.01). Conclusion. As a result, MR-FUS operations showed a significant decrease in BP during RIPC compared to the imitation, which confirms the angioprotective effect of preconditioning.

1. Galimova RM, Illarioshkin SN, Buzaev IV, Kachemaeva OV. Therapy of movement disorders by focused ultrasound under the control of magnetic resonance imaging. Recommendations for neurologists on the selection of patients. Byulleten’ Natsional’nogo obshchestva po izucheniyu bolezni Parkinsona i rasstroystv dvizheniy. 2020;(1):9-15. (In Russ.). Doi: 10.24411/2226-079X-2020-12168.

2. Illarioshkin S.N., Ivanova-Smolenskaya I.A., Shiveringhyperkinesis: guidelines for physicians. Moscow, Izdatel′skiy kholding «Atmosfera», 2011:35. (In Russ.).

3. Krishnamoorthy V, Chaikittisilpa N, Kiatchai T, Vavilala M. Hypertension After Severe Traumatic Brain Injury: Friend or Foe? J Neurosurg Anesthesiol. 2017;29(4):382-387. Doi: 10.1097/ANA.0000000000000370.

4. Than S, Srikanth V. Detecting brain injury related to hypertension at mid-life: a key to interventions for preventing dementia in older age. Cardiovasc Res. 2018;114(11):14301431. Doi: 10.1093/cvr/cvy170.

5. Dezfulian C, Garrett M, Gonzalez NR. Clinical application of preconditioning and postconditioning to achieve neuroprotection. Transl. Stroke Res. 2013;4(1):19-24. Doi: 10.1007/s12975-012-0224-3.

6. Zagidullin NS, Dunayeva AR, Plechev VV, Gilmanov AZ, Zagidullin SZ, Er F, Pavlov VN. Nephroprotective effects of remote ischemic preconditioning in coronary angiography. Clin Hemorheol Microcirc. 2017;65(3):299-307. Doi: 10. 3233/CH-16184.

7. Sprick JD, Mallet RT, Przyklenk K, Rickards CA. Ischaemic and hypoxic conditioning: potential for protection of vital organs. Exp Physiol. 2019;104(3):278-294. Doi: 10.1113/ EP087122.

8. Yunoki M, Kanda T, Suzuki K, Uneda A, Hirashita K, Yoshino K. Ischemic Tolerance of the Brain and Spinal Cord: A Review. Neurol Med Chir (Tokyo). 2017;57(11):590-600. Doi: 10.2176/nmc.ra.2017-0062.

9. Zagidullin N, Scherbakova E, Safina Y, Zulkarneev R, Zagidullin S. The Impact of Remote Ischemic Preconditioning on Arterial Stiffness and Heart Rate Variability in Patients with Angina Pectoris. J Clin Med. 2016;5(7):60. Doi: 10.3390/ jcm5070060.

10. Harrison TN, Zhou H, Wei R, Brettler J, Muntner P, An J, Ong-Su AL, Reynolds K. Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System. JAMA Netw Open. 2023;6(1):e2249930. Doi: 10.1001/jamanetworkopen. 2022.49930.

11. Katsi V, Papakonstantinou I, Solomou E, Antonopoulos AS, Vlachopoulos C, Tsioufis K. Management of Hypertension and Blood Pressure Dysregulation in Patients with Parkinson’s Disease-a Systematic Review. Curr Hypertens Rep. 2021;23(5):26. Doi: 10.1007/s11906-021-01146-5.

12. Liang Y, Li YP, He F, Liu XQ, Zhang YZ. Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease. Braz J Med Biol Res. 2015;48(06):568-576. Doi: 10.1590/1414431X20144452.

13. Manchurov VN, Ryazankina NB, Reztsov RYu, Skrypnik DV, Vasilieva EYu, Shpektor AV. Effect of remote ischemic preconditioning and postconditioning on blood flow in the infarct-related artery and endothelial function in patients with ST-elevation myocardial infarction. Kardiologiya. 2016;56(1):6-11. (In Russ.). Doi: 10.18565/cardio. 2016.1.6-11.

14. Müller J, Taebling M, Oberhoffer R. Remote Ischemic Preconditioning Has No Short Term Effect on Blood Pressure, Heart Rate, and Arterial Stiffness in Healthy Young Adults. 2019;10:1094. Doi: 10.3389/fphys.2019.01094.