Repeated remote ischemic post-conditioning (RIPC) combined with intravenous thrombolysis (IVT) can promote nerve function recovery and improve prognosis in patients with acute ischemic stroke, according to study results published in Neurology.

RIPC has recently been suggested for stroke treatment, and has been well tolerated and safe in patients when administered in a single episode following acute stroke. Study researchers sought to evaluate the impact of RIPC on patients with acute ischemic stroke undergoing IVT.

To achieve this, they conducted a single-center study which included patients with acute ischemic stroke who were receiving IVT at a hospital in China (ClinicalTrials.gov Identifier: NCT03218293). Patients were randomly assigned to an RIPC treatment group (n=34) or a non-RIPC control group (n=34).

The study’s primary outcome was the percentage of patients with a favorable outcome (a score of 0 or 1 on the modified Rankin scale [mRS]) at 90 days. Each patient had received IVT within approximately 4.5 hours of symptom onset. The study researchers also assessed the safety and tolerability of RIPC and examined the neuroprotection biomarkers associated with this approach.


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The mean duration of RIPC was 11.2 days (range, 8-14 days). At admission, there were no significant differences between the RIPC and control groups in terms of the National Institute of Health stroke scale score (6.5 vs 4.5, respectively; P =.364) or time to treatment (181.2 vs 179.2 minutes; P =.889).

A significantly greater proportion of patients in the RIPC arm experienced an excellent recovery at 3 months, defined as an mRS of 0 to 1, compared with the control group (71.9% vs 50.0%, respectively; adjusted risk ratio, 9.85; 95% CI, 1.54-63.16; P =.016). Compared to patients in the control group, those randomly assigned to RIPC also had lower plasma S100-β (P =.007) and higher vascular endothelial growth factor (P =.003) levels.

Limitations of this study included its single-center design, the relatively small number of patients included, and the lack of assessment of infarct size and its relation to RIPC.

Ultimately, study researchers concluded that “this novel treatment of combined IV tPA and RIPC may…improve the prognosis of patients with AIS [acute ischemic stroke].”

Reference

An JQ, Cheng YW, Guo YC, et al. Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke. Published online October 7, 2020. Neurology. doi:10.1212/WNL.0000000000010884