The following is a summary of “Remote Ischemic Conditioning With Medical Management or Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis,” published in the March 2024 issue of Neurology by Li, et al.

Despite promising features, the true benefit of remote ischemic conditioning (RIC) for acute ischemic stroke (AIS) remains unclear. Recent RCTs, including RESIST, might help identify which patients could see the most advantage from this therapy.

Researchers started a retrospective study to assess the pooled data from randomized controlled trials and evaluate the effectiveness and safety of RIC for ischemic stroke patients undergoing various treatments.

They conducted a comprehensive search across PubMed, Embase, Cochrane, Elsevier, and Web of Science databases, covering articles in all languages (May 25, 2023). The primary endpoint focused on the modified Rankin Scale (mRS) score at the specified endpoint time in the trial, with secondary outcomes including changes in the NIH Stroke Scale (NIHSS) and recurrence of stroke events. Safety assessments encompass cardiovascular events, cerebral hemorrhage, and mortality. Article quality was assessed using the Cochrane risk assessment tool.

The results showed 7,657 patients from 22 RCTs. RIC did not improve mRS outcomes compared to controls, regardless of medical management, intravenous thrombolysis (IVT), or mechanical thrombectomy (MT). However, in the medical management group, RIC reduced stroke recurrence (RR 0.63, 95% CI 0.43–0.92, P=0.02) and lowered NIHSS score by 1.72 points (P<0.00001). No elevated risks of adverse events were found in either the IVT or medical management group.

Investigators concluded that RIC benefited stroke patients ineligible for reperfusion, improved short-term outcomes, and reduced future strokes, but did not affect patients receiving reperfusion therapies.

Source: neurology.org/doi/10.1212/WNL.0000000000207983