ESOC 2023 – Late Breaking Abstracts

Background and aims: Remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is cerebroprotective in preclinical models and some clinical stroke trials.We investigated whether combined prehospital and in-hospital RIC improves functional outcome in patients with acute stroke.Methods: We performed a multicenter, prospective, randomized, patient-assessor blinded, sham-controlled study.Eligible patients were adult, independent in activities of daily living, had prehospital stroke symptoms with a duration <4 hours.Patients were randomly assigned to RIC or sham.Treatment was started in the ambulance and continued in-hospital.The primary endpoint was improvement in functional outcome measured as shift across the modified Rankin Scale in the target population with a final diagnosis of ischemic or hemorrhagic stroke.Results: From March 16, 2018, to November 11, 2022, 1500 patients underwent prehospital randomization.Median age was 71, and 591 (41%) were female.Of these, 149 (10%) patients were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic.In the remaining 902 patients with a target diagnosis of stroke a total of 436 were treated with RIC and 466 with sham.Treatment with RIC was not associated with a shift towards better functional outcome at 90 days (Odds ratio, 1.05; 95% confidence interval,0.83-1.33,p=0.67).We found no significant effect on key secondary endpoints and no safety concerns.Conclusions: We did not show improvement on functional outcome of combined prehospital and in-hospital RIC among patients with acute stroke.Half the patients were included within the first hour after stroke onset.ClinicalTrials.gov:NCT03481777.