Remote ischemic conditioning improves neurologic function in patients with acute moderate ischemic stroke

Reperfusion therapies, including intravenous thrombolysis and endovascular thrombectomy, have been recommended as the most effective strategy for acute ischemic stroke (AIS) by current guidelines.

There was an enhanced probability of excellent neurologic function with remote ischemic conditioning in patients having acute moderate ischemic stroke when compared to usual care as per a recent trial published in 'JAMA Network.' 

Remote ischemic conditioning (RIC) involves repeated occlusion/release cycles on bilateral upper limb arteries. Literature shows that there is a neuroprotective effect with RIC but strong evidence in patients with ischemic stroke (AMIS) is lacking. Hence, researchers conducted a multicenter, open-label, blinded–end point, randomized clinical trial called the RICAMIS trial to assess the efficacy of RIC for AMIS from 2018, through 2021. 1893 patients with AMIS from 55 hospitals in China participated in the study. 

In this randomized clinical trial that included 1893 patients with acute moderate ischemic stroke, excellent neurologic function at 90 days in those randomized to remote ischemic conditioning compared with usual care occurred in 67.4% vs 62.0%, a difference that was statistically significant.

Eligible patients were randomly assigned within 48 hours after symptom onset to receive treatment with RIC (using a pneumatic electronic device and consisting of 5 cycles of cuff inflation for 5 minutes and deflation for 5 minutes to the bilateral upper limbs to 200 mm Hg) for 10 to 14 days as an adjunct to guideline-based treatment (n = 922) or guideline-based treatment alone (n = 971).

The primary end point was excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. All end points had blinded assessment and were analyzed on a full analysis set.

Results:

1893 participants with AMIS had a mean age of 65 years.

1776 completed the trial.

Among these there were 606 women.

The number with excellent functional outcomes at 90 days was 582 in the RIC group and 566 in the control group.

The proportion of patients with any adverse events was 6.8% in the RIC group and 5.6% in the control group.

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The researchers concluded that among adults with acute moderate ischemic stroke, treatment with remote ischemic conditioning compared with usual care significantly increased the likelihood of excellent neurologic function at 90 days. However, these findings require replication in another trial before concluding efficacy for this intervention.

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