Abstract 369: Remote Ischemic Conditioning for Acute Ischemic Stroke and Symptomatic Intracranial Stenosis: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Background Remote ischemic conditioning (RIC) is a simple, non‐invasive strategy proposed to enhance neuroprotection and vascular adaptation in ischemic stroke.Multiple randomized trials have assessed its utility in both acute management and secondary prevention, with mixed findings.While some studies demonstrated improved functional independence and reductions in recurrent ischemic events, others failed to show significant benefit.Despite its favorable safety profile and ease of application, current evidence remains inconsistent, highlighting the need for larger, well‐designed trials. Methods We systematically reviewed randomized controlled trials (RCTs) evaluating RIC in patients with acute ischemic stroke or symptomatic intracranial stenosis. Primary outcome was functional independence at 90 days (mRS 0‐1). Secondary outcomes included recurrent ischemic events, infarct growth, mortality, and safety. Random‐effects models were used for pooled analyses where appropriate. Results Six randomized controlled trials (RCTs; n≈6,296) were eligible for inclusion. In the acute stroke setting, the RICAMIS trial (n≈1,893) demonstrated improved functional independence (67.4% vs 62.0%; OR 1.27, 95% CI 1.05‐1.54), whereas the RESIST (n≈1,500) and RESCUE BRAIN (n=188) trials yielded neutral or nonsignificant findings. A pooled analysis of RICAMIS and RESCUE BRAIN indicated a modest benefit (RR 1.09, 95% CI 1.02‐1.17). For secondary prevention, the large RICA trial (n=3,033) showed no effect in the intention‐to‐treat analysis but reported a significant reduction in recurrent ischemic events among adherent patients (HR 0.76, 95% CI 0.59‐0.99). Infarct growth outcomes were inconsistent, while mortality and serious adverse events were comparable between remote ischemic conditioning (RIC) and control groups. The most common minor adverse effect was local limb discomfort. Conclusions RIC appears safe and may modestly improve functional outcomes in acute ischemic stroke, though results are largely driven by a single large trial. For intracranial stenosis, long‐term efficacy may depend on adherence. Current evidence highlights the potential of RIC but underscores the need for further large‐scale, rigorously controlled studies.