Safety and Efficacy of Remote Ischemic Conditioning on Cerebral Amyloid Angiopathy. (RIC-CAA)

Study Overview
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Brief Summary
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Cerebral amyloid angiopathy (CAA) is a common form of cerebral small vessel disease, characterized by symptomatic intracerebral hemorrhage and cognitive impairment. However, no effective prevention and treatment strategies have been established. This study aims to evaluate the safety and efficacy of remote ischemic conditioning on patients with CAA.

Detailed Description
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CAA is a cerebrovascular disease caused by the deposition of β-amyloid in the walls of arteries, arterioles, and capillaries in the cerebral cortex and overlying leptomeninges. It is often associated with repeated lobar intracerebral hemorrhages, progressive cognitive decline, transient neurological symptoms and gait disturbances. No treatment is specific for symptomatic management of CAA up to date. Remote ischemic conditioning is a non-invasive strategy to protect the brain. The clinical trials have demonstrated that daily limb RIC seems to be potentially effective in patients with cerebral small-vessel disease in slowing cognition decline and reducing white matter hyperintensities. Thereby, investigators design this study to assess whether RIC has a beneficial effect on CAA.

Official Title
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Safety and Efficacy of Remote Ischemic Conditioning in Patients With Cerebral Amyloid Angiopathy: A Prospective, Randomized, Controlled Study

Conditions
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Cerebral Amyloid Angiopathy

Intervention / Treatment
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* Device: Remote ischemic conditioning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age≥55 and ≤85. The diagnosis of probable CAA and probable CAA with supporting pathology by the Boston criteria. Signed and dated informed consented is obtained. Exclusion Criteria: Familial hereditary CAA or other hereditary small-vessel disorders. Previous intracranial hemorrhage caused by other reasons, such as tumor, cerebral cavernous angioma, ruptured aneurysm, arteriovenous malformation, venous sinus thrombosis and so on. A history of stroke within 3 months. The degree of intracranial or extracranial large artery stenosis >50%. Clinical diagnosis of probable AD by National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria. Significant cognitive impairment (defined as Mini-mental State Examination (MMSE) score of ≥20 (primary school) or ≥24 (junior school or above) or other diseases resulting from severe cognitive impairment. Inability to walk 6m unaided or other conditions that affected gait performance, such as Parkinson. Illiteracy and patients with severe visual or hearing impairment. Contraindication to MRI scan, such as intracranial metal implants, cardiac pacemaker, severe claustrophobia, history of seizures and so on. Patients with missing or poor-quality MRI sequences at baseline and follow-up. Patients with a pre-existing neurological deficits (modified Ranks scale score >2) or psychiatric disease that would confound the neurological or functional evaluations. Alcohol dependence and other psychoactive substance abuse Contraindication for remote ischemic conditioning: severe soft tissue injury, limb deformities, fracture, atrial fibrillation or peripheral vascular disease in the upper limbs. Life expectancy of less than 1 year due to co-morbid conditions. Severe, sustained hypertension (SBP > 180 mmHg or DBP > 110 mmHg). Severe renal or hepatic disease. Known pregnancy (or positive pregnancy test), or breast-feeding. Concurrent participation in another research protocol for investigation of another experimental therapy. Any condition which, in the judgment of the investigator, might increase the risk to the patient.

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: RIC group<br>RIC treatment and regular treatment. | Device: Remote ischemic conditioning<br>* RIC is a non-invasive therapy that performed by an electric auto-control device with cuff placed on arm. RIC procedures consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on one arm. The procedure will be performed twice daily for consecutive 1 years after enrollment.<br>|
| No Intervention: Regular treatment<br>Regular treatment alone. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes of volume of WMHs. | The volume of WMHs was measured on Flairs at 6months and 12months. | From baseline to 6 months and 1 year treatment. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events related to RIC treatment. | Adverse events related to RIC treatment, such as mucocutaneous hemorrhage, changes in coagulation function and so on. | From baseline to 6 months and 1 year treatment. | 
| Incidence of cardio-cerebral vascular events. | Incidence of cardiovascular and cerebrovascular events,such as Intracranial hemorrhage, subarachnoid hemorrhage, CAA-related transient focal neurological episodes（CAA-TFNEs）, CAA-related Inflammation（CAA-ri），ischemic stroke during follow-up. | From baseline to 6 months and 1 year treatment. | 
| Changes of the cerebral blood flow in MRI ASL. | Changes of the CBF are assessed by Arterial Spin Labeling (ASL) MRI techniques at 6months and 12months. | From baseline to 6 months and 1 year treatment. | 
| Changes of cognition evaluation on MoCA. | We used MoCA to evaluate the cognitive functions,of subjects at 6months and 12months, such as memory, execution, visuospatial function and so on. | From baseline to 6 months and 1 year treatment. | 
| Changes of cognition evaluation on TMT tests. | We used TMT tests to evaluate execution and and so on at 6months and 12months. | From baseline to 6 months and 1 year treatment. | 
| Changes of cognition evaluation on stroop tests. | We used stroop tests to evaluate execution and and so on at 6months and 12months. | From baseline to 6 months and 1 year treatment. | 
| Changes in evaluation of Timed-Up-and-Go tests. | We used Timed-Up-and-Go tests to evaluate the gait function of subjects at 6months and 12months. | From baseline to 6 months and 1 year treatment. | 
| Changes of the whole volume of microbleeds. | The volume of microbleeds was measured on QSM at 6months and 12months. | From baseline to 6 months and 1 year treatment. |