Remote Ischemic Conditioning for Acute Stroke: The RESIST Randomized Clinical Trial

Area of Science:

• Neurology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Remote ischemic conditioning (RIC) involves cycles of limb ischemia and reperfusion.
• Preclinical and clinical data on RIC for acute stroke have shown some promise.
• The effectiveness of prehospital-initiated RIC for acute stroke remains uncertain.

Purpose of the Study:

• To evaluate the effect of RIC, initiated pre-hospital and continued in-hospital, on functional outcomes in acute stroke patients.
• To determine if RIC improves the modified Rankin Scale (mRS) score at 90 days.

Main Methods:

• A randomized clinical trial involving 1500 patients with acute stroke symptoms.
• RIC was administered using an inflatable cuff, with cycles of inflation and deflation.
• Treatment was initiated in ambulances and continued in hospitals for up to 7 days.

Main Results:

• Among 902 patients with confirmed stroke, RIC did not significantly improve functional outcomes at 90 days (mRS shift: OR, 0.95; P=.67).
• No significant differences in serious adverse events were observed between the RIC and sham groups.
• Increased incidence of upper extremity pain and skin petechiae was noted in the RIC group.

Conclusions:

• Prehospital-initiated RIC, continued in-hospital, did not significantly improve functional outcomes in acute stroke patients.
• The study did not support the use of RIC as an effective treatment for improving functional outcomes in acute stroke.
• Further research may be needed to explore potential benefits or alternative protocols for RIC in stroke management.