Research progress of remote ischemic conditioning in hemorrhagic stroke

Remote ischemic conditioning (RIC) is a noninvasive, safe, and well-tolerated non-pharmacological treatment that has shown application prospects in the field of ischemic stroke. However, its application in hemorrhagic stroke is still at an early stage, the mechanism has not been fully elucidated, and clinical evidence is relatively scarce. This review found that for ICH, the mechanism of RIC may involve coordinated metabolic and immune pathways. Clinical trials have confirmed its safety, but the efficacy conclusions are inconsistent: studies involving interventions in the subacute phase have shown the potential to promote hematoma resolution, while studies involving interventions in the ultra-early phase have failed to show improvements in functional outcomes. For subarachnoid hemorrhage, the research is more preliminary, and there is no randomized controlled trial (RCT). The underlying mechanisms are thought to involve immune inflammation and vascular reactivity, while existing pilot studies have mainly focused on verifying safety rather than efficacy. In conclusion, RIC is safe when applied to hemorrhagic stroke, but its therapeutic effectiveness has not been demonstrated. Significant gaps remain, including uncertainty about the optimal timing and dosing regimens for interventions and the lack of large, multicenter trials. Future research should focus on identifying biomarkers, standardizing treatment protocols, and conducting high-quality RCTs.