Abstract WP054: Remote Ischemic Conditioning for the Acute Treatment of Ischemic and Hemorrhagic Stroke: A Systematic Review and Meta-Analysis

Introduction: Remote ischemic conditioning (RIC), a low-cost, non-invasive therapy involving brief cycles of limb ischemia and reperfusion, may be a neuroprotective adjuvant or alternative to reperfusion therapies in acute ischemic stroke (AIS), and may have therapeutic effects in hemorrhagic stroke (HS). This systematic review and meta-analysis evaluated the efficacy of RIC in AIS and HS, focusing on functional and neurological outcomes, cerebral blood flow (CBF) and markers of cerebrovascular injury. Methods: This review was registered in PROSPERO (CRD42024549594). We searched MEDLINE, Embase, and Web of Science up to July 11, 2025. Eligible studies included RCTs assessing RIC initiated in adults within 96 hours of stroke onset. The primary outcomes were functional (modified Rankin Scale mRS) and neurological status (NIH Stroke Scale/Score NIHSS) at less than 7, 8-89, and 90 days. Secondary outcomes included CBF, infarct volume, and perihematomal edema. Data were pooled using fixed and random-effects models, generating standardized mean differences (SMDs) and odds ratios (ORs) with study heterogeneity assessed through Cochran’s Q. Results: A total of 32 studies (31 RCTs) with 5,580 participants (36% female) were included – 26 RCTs (N=5,399) in AIS and 5 in HS (N=181). mRS at <90 days (SMD=-0.29, 95%CI -0.54 to -0.03, N=3 RCTs) and NIHSS scores at 8-89 days (SMD=-0.83, 95%CI -1.36 to -0.30, N=8) improved in AIS patients who received RIC but not at other time-points. No significant differences between RIC and control groups were observed in HS patients for both mRS and NIHSS scores. There was no significant benefit of RIC on physiological outcomes. When comparing studies that provided reperfusion therapies to those that did not, improvement was seen in AIS patients who did not receive reperfusion therapies with RIC for mRS scores at 90 days (SMD=-0.52, 95%CI -0.89 to -0.16, N=4) and NIHSS scores at 8-89 days (SMD=-0.87, 95%CI -1.53 to -0.22, N=6). Conclusions: RIC appears to improve short-term functional and neurological outcomes in AIS, while no effect was observed from the limited trials of HS. Evidence for physiological mechanisms of treatment effect is limited. Further, significant pooled effects in 90-day functional outcomes were observed in AIS only when the intervention was used alongside standard care without reperfusion therapies, suggesting RIC may be an effective alternative for patients ineligible for reperfusion therapies.