The American Journal of Stroke reports that continuous, vigorous leg compressions on a patient after a stroke can activate intrinsic protective mechanisms that can reduce the damage caused by the stroke. Dr. David Hess, chairman of the Department of Neurology at the Medical University of Georgia, said that when tPA is used, leg compressions followed by relaxation every 5 minutes can increase the effectiveness of tPA by a factor of 1. “This is a potentially inexpensive, effective and safe stroke treatment, with only a brief period of discomfort during the procedure.” said Hess, author of the study published in the journal Stroke. In the emergency room, lower extremity compressions can be performed with a sphygmomanometer cuff while preparing for tPA treatment, the only drug currently approved by the FDA for stroke treatment. “It’s like preparing yourself before you run a marathon, you’re getting yourself into shape, you’re conditioning your body to survive a stroke,” Hess said of the technique, which is also used in emergency vehicles or in small rural hospitals. The study’s principal investigator and corresponding author is Dr. Nasrul Hoda of the Medical College of Georgia, who developed an animal model of internal carotid artery embolism, the most common cause of stroke. The compression technique, called distal ischemic adaptation, reduced the stroke area of the animals by 25.7%, slightly better than the results of tPA. The combination of the two reduced stroke area by 50% and extended the treatment time window for tPA. Hess said the next step in the study includes finding biomarkers that researchers can easily measure to evaluate whether it works in people. One marker is increased cerebral blood flow, which has been shown in animals in the treatment group. The first clinical trial to be conducted involves strapping a sphygmomanometer cuff to the leg of a small group of stroke patients to see if it increases cerebral blood flow. The researchers are also planning to study blood flow in normal people before and after compression to look for more reliable biomarker changes. They also want to do another animal trial to see if compression works better after tPA is used. Clinical evidence has suggested that distal ischemic adaptation can aid in recovery from heart disease, including a 2010 study in The Lancet that used both compression techniques and angioplasty to reduce heart damage in patients with heart disease. It would seem that this should also be the case, with patients with a prior history of transient insufficiency (angina and transient ischemic attack) recovering better than those without that history in patients who also had a serious vascular event (severe stroke or heart attack).