Efficacy and safety of remote ischemic conditioning for acute ischemic stroke: A comprehensive meta‐analysis from randomized controlled trials

Abstract

Background and Purpose Remote ischemic conditioning (RIC) is a remote, transient, and noninvasive procedure providing temporary ischemia and reperfusion. However, there is no comprehensive literature investigating the efficacy and safety of RIC for the treatment of acute ischemic stroke. In the present study, we performed a comprehensive meta‐analysis of the available studies. Methods MEDLINE, Embase, the Cochrane Library database (CENTRAL), and http://clinicaltrials.gov were searched before Sep 7, 2022. The data were analyzed using Review Manager 5.4.1 software, Stata version 16.0 software, and R 4.2.0 software. Odds ratio (OR), mean difference (MD), and corresponding 95% CIs were pooled using fixed‐effects meta‐analysis. Results We pooled 6392 patients from 17 randomized controlled trials. Chronic RIC could reduce the recurrence of ischemic stroke at the endpoints (OR 0.67, 95% CI [0.51, 0.87]). RIC could also improve the prognosis of patients at 90 days as assessed by mRS score (mRS 0–1: OR 1.29, 95% CI [1.09, 1.52]; mRS 0–2: OR 1.22, 95% CI [1.01, 1.48]) and at the endpoints assessed by NIHSS score (MD −0.99, 95% CI [−1.45, −0.53]). RIC would not cause additional adverse events such as death (p = 0.72), intracerebral hemorrhage events (p = 0.69), pneumonia (p = 0.75), and TIA (p = 0.24) but would inevitably cause RIC‐related adverse events (OR 26.79, 95% CI [12.08, 59.38]). Conclusions RIC could reduce the stroke recurrence and improve patients' prognosis. Intervention on bilateral upper limbs, 5 cycles, and a length of 50 min in each intervention might be an optimal protocol for RIC at present. RIC could be an effective therapy for patients not eligible for reperfusion therapy. RIC would not cause other adverse events except for relatively benign RIC‐related adverse events.

Efficacy of remote ischemic conditioning in acute ischemic stroke patients receiving thrombolysis and thrombectomy: a meta-analysis

“…Based on Figure 2, patients treated with RIC decreased the recurrence of ischemic stroke. This was the same in a previous study done by Kan et al in 2023. RIC generally showed advantages compared with sham RIC/control in improving the prognosis and dependency of a patient as seen in Figures 3 and 4.…”

“…Bilateral limb occlusion might be more beneficial in improving the outcomes at 90 days. Kan et al (2023) stated that bilateral limb occlusion for 5 cycles at a length of 50 mins might be an optimal protocol for AIS patients. This may be due to the increased neuronal, humoral, and immunomodulatory factors involved as compared to occluding a unilateral limb alone.…”