Remote Ischemic Conditioning and Cerebral Oxygen Saturation: The Cerebral Oxygenation–Conditioning Response (Co-CoRe) Framework

Remote ischemic conditioning (RIC) is a promising noninvasive intervention that may enhance endogenous cerebroprotective mechanisms following ischemic stroke. Although clinical studies suggest potential benefits, the physiological mechanisms underlying RIC remain incompletely understood, particularly whether RIC-associated hemodynamic changes are accompanied by changes in cerebral tissue oxygenation. No conceptual framework currently integrates these relationships to guide future research. The purpose of this paper is to present the Cerebral Oxygenation–Conditioning Response (CO-CoRe) Framework, a mechanistic conceptual framework describing the hypothesized relationships among RIC, compensatory cerebral blood flow, cerebroprotection, and cerebral regional oxygen saturation (CrSO₂) following ischemic stroke. The CO-CoRe Framework integrates evidence-supported relationships among RIC, compensatory cerebral blood flow, and cerebroprotection with a hypothesized relationship between RIC and CrSO 2 , providing a mechanistic foundation for examining cerebral tissue oxygenation following ischemic stroke. By synthesizing current evidence on ischemic conditioning, cerebrovascular physiology, and cerebral tissue oxygenation, the CO-CoRe Framework generates testable hypotheses and provides a foundation for future research evaluating CrSO₂, measured using near-infrared spectroscopy, as a physiological response to RIC. Ultimately, the framework may advance understanding of RIC-associated cerebroprotection and inform physiologic monitoring strategies in ischemic stroke.