Effects of Remote Ischemic Conditioning on Cerebral Blood Flow Regulation in Atherosclerosis: A Randomized Trial

Impaired dynamic cerebral autoregulation (dCA) contributes to cerebral perfusion instability in patients with cerebrovascular atherosclerosis. Remote ischemic conditioning (RIC) has shown neuroprotective potential; however, its acute effects on dCA in this population remain unclear. In this randomized, sham‐controlled trial, patients with intracranial atherosclerotic stenosis (ICAS) and/or extracranial atherosclerotic stenosis (ECAS) received a single session of RIC or sham‐RIC. dCA was assessed at baseline and at 0–1, 6–9, and 24 h using transfer function analysis. The prespecified primary endpoint was the affected‐side phase difference (PD) at 6–9 h. Of the 140 randomized participants, 132 with valid primary endpoint data were included in the primary analysis. For the primary outcome, the affected‐side PD at 6–9 h was significantly greater in the RIC group than in the sham‐RIC group (adjusted β = 12.166, 95% CI: 6.787–17.545; p < 0.001). Secondary analyses at other time points and of the unaffected side supported an acute physiological effect of RIC on dCA. These findings suggest that a single RIC session may rapidly improve impaired dCA in patients with ICAS and/or ECAS. Larger studies are needed to determine whether this response varies across clinical presentations and vascular territories.