Episode 055 -- Remote Ischemic Conditioning

Strokecast regular, neurologist Dr. Nirav Shah joins us again this week to talk about Remote Ischemic Conditioning. Essentially it makes the body more resistant to oxygen deprivation by depriving it of oxygen. It's a fascinating area.

In some respects, it does the opposite of hyperbaric oxygen therapy. As we learned in episode 48, the theory is that Hyperbarics, which floods the body with extra oxygen at high pressure can bring back the stroke damaged brain tissue and help with recovery. And while hyperbaric oxygen therapy does help for a lot of conditions, the science doesn't back it up for stroke.

Remote Ischemic conditioning does appear to have positive results in the early studies and may be helpful in the future.

Does this mean you should go ahead and tie a tourniquet around your limbs to give it a shot? Absolutely not. That would be a terrible idea. At least for now.

I like the potential in Remote Ischemic Conditioning. I also like that it is potentially simple, inexpensive, and something I can do at home. Sure, it might be physically uncomfortably, but if it works, I think Io can get past that. For many of us, that discomfort may be minor compared to the other things we deal with on a regular basis.

Of course this is all still preliminary. There's research to be done.

Another thing that's interesting to think about is how something that's bad can still have positive outcomes. And yet that doesn't make up for the problem itself. It's sort of a Mussolini made the trains run on time kind of thing.

Specifically, the issue of smoking. Smoking causes some remote ischemic conditioning. As we talked about that means smokers may have less severe stroke. Good, right?

Except smoking causes many of those strokes in the first place!

The best way to minimize the effect of stroke is not to have one in the first place.

Finally, the other thing about this episode that makes me smile is that it added the phrase "vascular milieu' to my vocabulary. And that's just delightful.

To hear more from Nirav, head on over to Strokecast.com/nirav to find all his Strokecast interviews.


Dr. Nirav H Shah HeadshotDr. Nirav H. Shah is a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging.

He is a practicing neurohospitalist and served as the stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. He enjoys mentoring trainees and collaborating on publications and conference presentations.

Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit.

Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer.

Hack of the Week

If you struggle with communicating and meeting new people, prepare a preprinted bio and bring it with you.

An attendee with aphasia came to our support group recently and brought such a Bio. When it was her turn to introduce herself, she was able to hand me that sheet to read for the group. 

This can be a great way to meet other people and can relieve a lot of anxiety. If you want to get fancy, you could even laminate it.

This can also be helpful even if you can usually speak well. Sometimes stressful situations (like traffic stops) can make the words tougher to grab. A preprinted bio or introduction can help quite a bit.



Nirav's other Appearances


Hyperbaric Oxygen Therapy


Kristen Talks about Sleep Apnea


Nirav  on LinkedIn


Nirav at Swedish


Nirav on Twitter


The Neurohospitalist


Nirav’s Photography


Sentinel Healthcare


Remote Ischemic Conditioning: From Bench to Bedside


RECAST (Remote Ischemic Conditioning After Stroke Trial)


Remote ischemic conditioning for stroke: clinical data, challenges, and future directions


Immediate remote ischemic postconditioning reduces cerebral damage in ischemic stroke mice by enhancing leptomeningeal collateral circulation


Remote limb ischemic postconditioning promotes motor function recovery in a rat model of ischemic stroke via the up‐regulation of endogenous tissue kallikrein



Where do we go from here?

  • To hear more from Nirav, head on over to Strokecast.com/nirav to find all his Strokecast interviews.
  • Tell a friend, colleague, relative or patient about Strokecast.
  • Don't get best…get better.


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