A Study on the Efficacy and Safety of Remote Ischemic Conditioning Therapy Versus Optimal Medical Therapy in Reducing the Recurrence of Ischemic Events in Symptomatic Moyamoya Disease
This clinical trial aims to investigate whether remote ischemic conditioning (RIC) can reduce the risk of cerebral ischemic events, delay clinical progression, and improve long-term outcomes in patients with symptomatic Moyamoya disease (Moyamoya syndrome). The primary research questions include: Does RIC lower the incidence of cerebral ischemic events (e.g., stroke, transient ischemic attack) compared to standard care? Does RIC slow disease progression, as measured by neuroimaging markers (e.g., cerebral blood flow, collateral vessel development) and clinical assessments? Does RIC improve long-term functional outcomes (e.g., modified Rankin Scale, quality of life) in this patient population? Study Design This is a multicenter, prospective, double-blind, randomized controlled trial (RCT). Eligible participants who provide informed consent and complete baseline evaluations will be dynamically randomized (1:1) via a central randomization system using the minimization method to either the intervention group or the control group. Intervention Group: Patients will receive RIC therapy (using an automated device) in addition to optimal medical treatment (OMT). RIC will be administered twice daily for 6 months, with each session consisting of 5 cycles of bilateral upper-limb cuff inflation (5 min at a preset high pressure) followed by deflation (5 min), totaling \ 45 min per session. OMT includes antiplatelet agents, antihypertensives, antidiabetics, and lipid-lowering drugs as clinically indicated. Control Group: Patients will receive a sham RIC procedure (using the same device but with cuffs inflated to a fixed low pressure of 60 mmHg) alongside identical OMT. The frequency, duration, and cycling protocol will match those of the intervention group.
• The patient is aged between 18 and 70 years old;
• There is evidence from MRA, CTA or DSA, and the patient is professionally diagnosed with moyamoya disease or moyamoya syndrome;
• The patient has ischemic symptoms related to moyamoya vasculopathy, including transient ischemic attack (TIA) and cerebral infarction (limb weakness, hemiplegia, paresthesia, speech disorder, etc. The symptoms may recur in the unilateral limb, or progress to bilateral attacks or alternating bilateral attacks);
• After clinical evaluation, non-surgical treatment strategies such as drug therapy and risk factor management are planned to be adopted currently, and the patient is not planned to undergo cerebral blood flow revascularization within 6 months after randomization during screening;
• The patient has signed the informed consent form.