The effect of remote ischemic conditioning combined with tirofiban on early neurological deterioration in small artery occlusive stroke

OBJECTIVES: Early neurological deterioration (END) remains a significant challenge in the treatment of small artery occlusive (SAO) stroke. The purpose of this study was to evaluate the efficacy and safety of remote ischemic conditioning (RIC) combined with tirofiban for patients with SAO stroke experiencing END. METHODS: We retrospectively reviewed 143 consecutive patients with acute SAO stroke experiencing END who received intravenous tirofiban between January 2021 and December 2024. According to the use of RIC treatment, the patients were divided into RIC group (72 cases) and control (no-RIC) group (71 cases). The primary efficacy outcome was early neurological improvement (a decrease of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) score at 7 days after END). The secondary efficacy outcomes included absolute reduction in NIHSS score at 7 days, modified Rankin Scale scores at 90 days, proportion of disabling stroke, recurrence of ischemic stroke within 90 days. The safety outcomes were symptomatic intracranial hemorrhage, any ICH, adverse events, and 90-day all-cause mortality. RESULTS: The RIC group exhibited a greater absolute reduction in NIHSS score at 7 days after treatment (mean ± SD: 1.67 ± 1.80 vs. 0.96 ± 1.91; adjusted P=0.015), and early neurological improvement was achieved in 55.6% of the RIC group and 29.6% of the control group (adjusted odds ratio, 3.34 [95% CI, 1.61-6.93]; P=0.001). No symptomatic intracranial hemorrhage or any intracranial hemorrhage occurred in either group. Additionally, the 90-day all-cause mortality did not differ significantly between the RIC and sham groups (1.4% vs. 2.8%, hazard ratio, 0.49 [95% CI, 0.04-5.41]; P=0.561). CONCLUSIONS: In patients with small artery occlusive stroke experiencing END, the combination of RIC and tirofiban seems associated with early neurological improvement without increasing the risk of intracranial hemorrhage or serious adverse events. Future multicenter, large-sample randomized clinical trials are warranted to validate these results.