Doctoral defence: Karl Kuusik "Effects of remote ischaemic preconditioning on arterial stiffness, organ damage and metabolomic profile in patients with lower extremity artery disease"

On June 20th 2024 Karl Kuusik will defend his thesis "Effects of remote ischaemic preconditioning on arterial stiffness, organ damage and metabolomic profile in patients with lower extremity artery disease".

Professor Jaak Kals, University of Tartu
Professor Jaan Eha, University of Tartu
Professor Mihkel Zilmer, University of Tartu

Professor Anne Lejay, Service de Chirurgie Vasculaire et Transplantation Rénale, Faculté de médecine, University of Strasbourg (France).

Remote ischemic preconditioning (RIPC) is a phenomenon aimed at protecting the body's tissues and organs from damage caused by disruptions in blood supply . In addition to emergency situations, such damage also occurs in the course of everyday planned medical activities, where the risk of complications associated with necessary treatment is higher in patients already burdened with significant disease and risks. One group of such patients includes those suffering from lower extremity arterial disease (LEAD). The RIPC procedure involves repeated short-term cycles of halting blood supply followed by its restoration, typically applied to the upper limb. This action generates a protective effect in organs or tissues sensitive to blood supply disruptions that are situated farther away.

This doctoral thesis investigated the effects of RIPC on LEAD patients following digital subtraction angiography (DSA) and percutaneous transluminal angioplasty (PTA) procedures, focusing on changes in arterial stiffness, indicators of kidney and heart damage, inflammation, oxidative stress, and metabolic profile. The study included 111 LEAD patients who were randomly divided between a RIPC group and a control group. Patients in the RIPC group underwent four consecutive episodes of short-term blood supply cessation on the upper arm using a blood pressure cuff, followed by a period of blood supply restoration. In control arm blood cuff was filled only partially.

The results showed that in the RIPC group, there was a significant improvement in arterial stiffness indicators and a reduction in mean arterial pressure, which were more pronounced after stent placement following the PTA procedure. However, there were no significant changes in markers of kidney and heart damage. The RIPC procedure had a significant impact on the inflammatory response and oxidative stress response, limiting the increase in certain health indicators, such as adiponectin levels, following the procedure. Furthermore, changes in the metabolomic profile of the RIPC group suggest the potential of RIPC to reduce damage caused by blood supply disruptions and their subsequent recovery.

In conclusion, RIPC is a safe and easily applicable method that reduces the risks associated with diagnostic and therapeutic procedures in LEAD patients, making treatment personalized and therefore also more effective.