Ischaemic preconditioning

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A technique aimed to allow tissue to survive better ischaemic events.

Direct ischaemic preconditioning

For example short periods of ischaemic occlusion of a coronary artery and reperfusion renders the myocardium more resistant to prolonged ischaemia.[1][2].

Remote ischaemic preconditioning

Remote ischaemic preconditioning of the myocardium, by provoking the ischaemia in a limb with a tourniquet reduces markers of myocardial ischaemia in elective coronary artery bypass graft surgery[3]. Three 5 minute cycles with five minutes reperfusion of the left arm after induction of anaesthesia reduces mortality over 1 and a half years follow up[4]. It is closely related to techniques to minimise myocardial reperfusion injury. Peripheral vascular disease acts as remote ischaemic preconditioning in acute ischaemic stroke[5].

References

  1. Yellon DM, Hausenloy DJ. Realizing the clinical potential of ischemic preconditioning and postconditioning. Nature clinical practice. Cardiovascular medicine. 2005 Nov; 2(11):568-75.(Link to article – subscription may be required.)
  2. Hausenloy DJ, Yellon DM. The evolving story of "conditioning" to protect against acute myocardial ischaemia-reperfusion injury. Heart (British Cardiac Society). 2007 Jun; 93(6):649-51.(Link to article – subscription may be required.)
  3. Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E, Ashley E, Vichare S, Di Salvo C, Kolvekar S, Hayward M, Keogh B, MacAllister RJ, Yellon DM. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet. 2007 Aug 18; 370(9587):575-9.(Link to article – subscription may be required.)
  4. Thielmann M, Kottenberg E, Kleinbongard P, Wendt D, Gedik N, Pasa S, Price V, Tsagakis K, Neuhäuser M, Peters J, Jakob H, Heusch G. Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial. Lancet. 2013 Aug 17; 382(9892):597-604.(Link to article – subscription may be required.)
  5. Connolly M, Bilgin-Freiert A, Ellingson B, Dusick JR, Liebeskind D, Saver J, Gonzalez NR. Peripheral vascular disease as remote ischemic preconditioning, for acute stroke. Clinical neurology and neurosurgery. 2013 Aug 6.(Epub ahead of print) (Link to article – subscription may be required.)
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