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

Area of Science:

• Neurology
• Cardiovascular Research
• Ischemic Stroke Research

Background:

• Preclinical studies suggest remote ischemic conditioning (RIC) offers neuroprotection.
• Clinical evidence for RIC's efficacy in acute ischemic stroke remains inconsistent.
• This study investigates RIC's effect on acute ischemic stroke, considering baseline severity.

Purpose of the Study:

• To evaluate the neuroprotective effect of remote ischemic conditioning (RIC) in patients with acute ischemic stroke.
• To assess if RIC improves functional outcomes at 90 days post-stroke.
• To analyze RIC's efficacy based on the baseline severity of ischemic stroke.

Main Methods:

• 79 patients with ischemic stroke (NIHSS 5-20) were randomized into RIC (n=43) and control (n=36) groups.
• RIC involved 4 cycles of 5-min cuff inflation/deflation daily for at least 3 days.
• Functional outcome was assessed at 90 days using modified Rankin Scale, with severity-based outcome definitions.

Main Results:

• No significant difference in good functional outcomes (modified Rankin Scale 0-3) was observed between RIC (16.3%) and control (22.2%) groups (OR, 0.73; P=0.502).
• Incidences of major adverse cardiovascular events, aspiration pneumonia, and serious adverse events were comparable between groups.
• The study may have been underpowered to detect a significant treatment effect.

Conclusions:

• Remote ischemic conditioning initiated within 48 hours of stroke onset did not demonstrate a significant benefit for functional outcomes in acute ischemic stroke.
• Further research may be needed to clarify RIC's role, potentially with larger, powered studies.
• Current findings suggest RIC is not a proven intervention for improving outcomes in acute ischemic stroke.