Neuroprotective Effect of Remote Ischemic Conditioning on Patients Undergoing Intravenous Thrombolysis: A Randomized Controlled Trial

ABSTRACT Intravenous thrombolysis (IVT) is the treatment with the highest level of evidence for acute ischemic stroke, but about half of patients fail to achieve a favorable prognosis. This study (NCT05598658) proposed a treatment strategy of adjunctive two sessions of remote ischemic conditioning (RIC) within 24 h after IVT, and evaluated the effects through cerebral autoregulation (CA) and brain‐injury biomarkers. Patients were randomized (1:1) to the RIC or sham‐RIC groups, which received 200 and 60 mmHg RIC, respectively, at 6 and 18–24 h after IVT. CA was assessed at 2 and 7 days after IVT and serum brain‐injury biomarkers were evaluated at 24 h after IVT. The primary outcome was CA at 2 days after IVT. A total of 100 patients were randomized to the RIC or sham‐RIC group. Ipsilateral CA was significantly higher in the RIC group than in the sham‐RIC group at 2 days (β: 14.970 95% confidence interval, 7.741–22.199; p < 0.001) and 7 days after IVT. Simultaneously, neuron‐specific enolase level at 24 h after IVT was significantly lower in the RIC than the sham‐RIC group. These results suggest that adjunctive two sessions of RIC within 24 h after IVT can effectively exert neuroprotective effects in patients with IVT.