Remote Ischemic Postconditioning in Endovascular Thrombectomy for Stroke: The EnTRIPS Randomized Clinical Trial

 

Is your doctor and stroke hospital so FUCKING INCOMPETENT THEY DIDN'T CREATE AND INSTALL A PROTOCOL ON THIS YEARS AGO?

Do you prefer your doctor and hospital incompetence being NOT KNOWING. Or NOT DOING?

remote ischemic postconditioning (5 posts to March 2021)

And much earlier, this might be 

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Remote Ischemic Postconditioning in Endovascular Thrombectomy for Stroke: The EnTRIPS Randomized Clinical Trial

Yawen Cheng, MD https://orcid.org/0000-0001-9841-9800, Wanying Chen, MD https://orcid.org/0000-0003-0812-1408, 

Mingze Chang, MD https://orcid.org/0000-0001-8475-6603, Xiangning Han, MS https://orcid.org/0000-0003-2282-6279, 

Jia Yu, MD https://orcid.org/0009-0001-9199-2046, Meng Wei, MD https://orcid.org/0009-0004-5765-7414, 

Yi Qi, MS, … Show All … , and Guogang Luo, MD https://orcid.org/0000-0003-3991-8962 lguogang@163.comAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.054857

 

Abstract

BACKGROUND:

Although the neuroprotective potential of remote ischemic postconditioning (RIPC) has been reported, the efficacy and safety of ultra-early RIPC administered after endovascular treatment (EVT) in patients with acute ischemic stroke remain unclear. This study evaluated the efficacy and safety of ultra-early RIPC in patients with acute ischemic stroke undergoing EVT.

METHODS:

The EnTRIPS trial (Endovascular Treatment Combined with Remote Ischemic Postconditioning in Patients with Acute Ischemic Stroke) was a multicenter, randomized, controlled, outcome assessor-blinded, prospective clinical trial. The trial was conducted at 8 hospitals in China between April 12, 2021, and March 26, 2025. Eligible patients were adults with acute ischemic stroke due to large vessel occlusion who presented within 24 hours of symptom onset, underwent EVT, and achieved successful recanalization. A total of 270 eligible patients were randomized within 6 hours after EVT to receive either RIPC plus guideline-based therapy (n=135) or guideline-based therapy alone (n=135). RIPC was administered for 7 days using pneumatic devices consisting of 5 cycles of bilateral upper-arm cuff inflation (5 minutes at 180 mm Hg) followed by deflation (3 minutes). The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2 (range, 0 [no symptoms] to 6 [death]). Safety outcomes included the incidence of RIPC-related adverse events within 7 days.

RESULTS:

Among 270 randomized patients, a total of 268 (99.3%) participants completed the trial, including 133 in the RIPC group and 135 in the control group (mean [SD] age, 65.5 [16.8] years; 171 [63.8%] men). At 90 days, functional independence was achieved in 81 (60.9%) patients in the RIPC group and 78 (57.8%) patients in the control group (adjusted risk ratio, 1.07 [95% CI, 0.89–1.30]; P=0.46). RIPC-related adverse events occurred in 10 of 133 (7.5%) patients, and no intervention-related adverse events occurred in the control group.

CONCLUSIONS:

Ultra-early RIPC is safe for patients with acute ischemic stroke treated with EVT, but it does not significantly improve the 90-day functional outcomes.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04581759.

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Effects of blood flow restriction therapy for lower limb dysfunction in stroke patients: a systematic review and meta-analysis

 Is this just a more extensive version of these? Does your doctor have a protocol for anything here? NO? So, COMPLETELY FUCKING INCOMPETENT then!

• leg wraps (9 posts to May 2013)

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Effects of blood flow restriction therapy for lower limb dysfunction in stroke patients: a systematic review and meta-analysis

• 

  Jun Zhang 1

• 

  YuXin Xiao 2

• L

  LiangYu Qiu 3

• G

  Gang Zhang 1

• R

  Rui Wang 1

• X

  XuePing Zhu 1

• C

  Chan Wang 1*

• M

  MingJun Xu 2*

• 1. Department of Acupuncture, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China

• 2. Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China

Abstract

Objective:

To systematically evaluate the efficacy of blood flow restriction training (BFRT) for lower limb dysfunction in stroke patients.

Methods:

Randomized controlled trials published up to October 2025 were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library. The control group received conventional rehabilitation, while the intervention group received conventional rehabilitation combined with BFRT.

Results:

Eleven studies involving 522 patients were included. The intervention group achieved significantly higher Berg Balance Scale scores [MD = 4.52, 95% CI (0.78, 8.26), p = 0.02] and longer 6-min walk test distances [MD = 9.73, 95% CI (7.26, 12.21), p < 0.00001]. Subgroup analysis showed that when the intervention duration exceeded 4 weeks, the intervention group achieved higher lower-extremity Fugl-Meyer Assessment scores [MD = 4.38, 95% CI (2.00, 6.77), p = 0.0003] and Modified Barthel Index scores [MD = 10.50, 95% CI (6.32, 14.68), p < 0.00001] than the control group. Among patients in the subacute phase, the intervention group also demonstrated higher lower-extremity Fugl-Meyer Assessment scores [MD = 2.63, 95% CI (0.42, 4.83), p = 0.02].

Conclusion:

BFRT improves balance and walking endurance in stroke patients. When delivered for more than 4 weeks, it yields additional benefits in lower limb motor function and activities of daily living, with more pronounced motor improvements observed in the subacute phase. Owing to limitations in sample size, treatment protocol heterogeneity, and methodological quality, these findings require confirmation through large-scale, high-quality studies.

Effect of RICAS (Remote Ischemic Preconditioning on Collaterals of Atherosclerosis Stroke): Rationale and Design

 

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remote ischemic postconditioning (3 posts to March 2021)

And much earlier, this might be 

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Effect of RICAS (Remote Ischemic Preconditioning on Collaterals of Atherosclerosis Stroke): Rationale and Design

Zi‐Ai Zhao, MD, Yan Lv, MD, and Hui‐Sheng Chen, MD https://orcid.org/0000-0002-7486-1992 chszh@aliyun.comAuthor Info & Affiliations

Journal of the American Heart Association

New online

https://doi.org/10.1161/JAHA.124.038570

• Abstract
• Nonstandard Abbreviations and Acronyms
• METHODS
• STATISTICAL ANALYSIS
• DISCUSSION
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Abstract

Background

As a noninvasive, low‐cost, nonpharmacological procedure with excellent properties of safety, remote ischemic conditioning (RIC) has been demonstrated to prevent recurrence of stroke among patients with ischemic stroke of large artery atherosclerosis origin. We hypothesized that the benefit is attributed to the improvement of collaterals by chronic RIC in this population, and we aimed to explore the influence of chronic RIC on collateral status evaluated by digital subtraction angiography in this population.

Methods

The RICAS (Remote Ischemic Preconditioning on Collaterals of Atherosclerosis Stroke) study is a prospective, randomized, blind end point, multicenter study. Eligible patients with ischemic stroke of anterior circulation caused by large artery atherosclerosis, poor collateral compensation, and more than 1 month of symptom onset, are randomly assigned into experimental and control groups with a ratio of 1:1. The patients in the experiment group will receive treatment with RIC (bilateral upper limbs, for a total procedure time of 50 minutes, twice daily) for 1 year as an adjunct to guideline‐based treatment, while patients in the control group only receive guideline‐based treatment. A maximum of 300 patients (150 participants per group) are required to test the superiority hypothesis with 80% power (using a 2‐sided α=0.05) to detect a 15% difference. Subgroup analyses for the primary end point will be performed on 8 prespecified subgroups by age, sex, ischemic event (acute ischemic stroke ore transient ischemic stroke), tandem lesion, history of hypertension, hypercholesterolemia, diabetes, and myocardial infarction. The primary outcome is the proportion of collateral status improvement, which is defined as an increase of ≥1 point on the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology score, as assessed by digital subtraction angiography at 12 months after randomization. The safety outcomes include RIC‐related adverse events.

Conclusions

This study may provide the direct evidence for the potential effect of chronic RIC treatment on the improvement of collateral status.

Registration

URL: https://clinicaltrials.gov. Unique identifier: NCT06170944.

Metabolic Syndrome and Efficacy of Remote Ischemic Postconditioning in Acute Moderate Ischemic Stroke: A Post Hoc Analysis of the RICAMIS Trial

 Is your doctor and stroke hospital so FUCKING INCOMPETENT THEY DIDN'T CREATE AND INSTALL A PROTOCOL ON THIS YEARS AGO?

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remote ischemic postconditioning (3 posts to March 2021)

And much earlier, this might be 

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Metabolic Syndrome and Efficacy of Remote Ischemic Postconditioning in Acute Moderate Ischemic Stroke: A Post Hoc Analysis of the RICAMIS Trial

Yi‐Na Zhang, MD https://orcid.org/0000-0003-0921-0058, Qiong Wu, MD, Yu Cui, PhD https://orcid.org/0000-0002-4925-1500, Nan‐Nan Zhang, MM https://orcid.org/0009-0000-4414-2906, and Hui‐Sheng Chen, MD https://orcid.org/0000-0002-7486-1992 chszh@aliyun.comAuthor Info & Affiliations

Journal of the American Heart Association

New online

https://doi.org/10.1161/JAHA.124.037859

• Abstract
• Nonstandard Abbreviations and Acronyms
• Clinical Perspective
• METHODS
• RESULTS
• DISCUSSION
• CONCLUSIONS
• Sources of Funding
• Acknowledgments
• Footnotes
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• References
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Abstract

Background

Metabolic syndrome (METS) is associated with poor outcomes after acute ischemic stroke. This study aimed to investigate the relationship between METS and efficacy of remote ischemic postconditioning (RIPostC) in acute moderate ischemic stroke using the database of the RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial.

Methods and Results

In the RICAMIS trial, eligible participants were patients with acute moderate ischemic stroke within 48 hours of onset who did not receive reperfusion treatment. A total of 1482 patients were enrolled in this secondary analysis, including the METS (602) and non‐METS (880) group according to the METS definitions of the Chinese Diabetes Society, which was further subdivided into RIPostC and control subgroups. The primary outcome was excellent functional outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The differences in clinical outcomes between the RIPostC subgroup and control subgroup were compared in patients with METS or non‐METS, respectively, and the interaction effects of RIPostC treatment assignment with METS status were evaluated. The baseline characteristics between RIPostC and control subgroups across patients with METS and non‐METS were well balanced, except the difference in Trial of Org 10 172 in Acute Stroke Treatment stroke mechanism in the METS group. Compared with control, RIPostC was associated with high probability of excellent functional outcome in patients with METS (68.8% versus 56.1%; odds ratio [OR], 1.751 [95% CI, 1.248–2.456]; P=0.001), but not in patients without METS (66.6% versus 64.6%; OR, 1.103 [95% CI, 0.833–1.461]; P=0.494). Notably, a significant interaction effect between treatments (RIPostC or control) by different METS status on excellent functional outcome was observed (P=0.039).

Conclusions

The secondary analysis suggests for the first time that RIPostC may provide greater benefit in patients with acute ischemic stroke with METS versus non‐METS.

Nonstandard Abbreviations and Acronyms

AIS

acute ischemic stroke

LAA

large artery atherosclerosis

METS

metabolic syndrome

NIHSS

National Institutes of Health Stroke Scale

RICAMIS

Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke

RIPostC

remote ischemic postconditioning

TOAST

Trial of Org 10172 in Acute Stroke Treatment

Clinical Perspective

What Is New?

•

This is the first report of patients with acute moderate ischemic stroke, within 48 hours of onset, who did not receive reperfusion treatment and in whom remote ischemic postconditioning treatment produced greater probability of excellent clinical outcome in patients with metabolic syndrome compared with patients without metabolic syndrome.

What Are the Clinical Implications?

•

Patients with acute moderate ischemic stroke with metabolic syndrome may get more benefit from remote ischemic postconditioning, which needs to be validated in future trials.(Why?)

Remote ischemic postconditioning (RIPostC), a noninvasive and nonpharmacological procedure performed by intermittently blocking the blood flow of both upper limbs, has been found to be potentially beneficial in acute ischemic stroke (AIS).^{1, 2} The recent RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial has demonstrated that RIPostC can improve 3‐month functional outcomes in patients with moderate AIS,³ although this finding was not confirmed by the RESIST (Remote Ischemic Conditioning in Patients With Acute Stroke) study.⁴ It is an important clinical concern to identify a suitable population who can benefit from RIPostC.

Metabolic syndrome (METS) represents a clustering of metabolic abnormalities, including 4 core components: dyslipidemia, elevated blood pressure, abnormal blood glucose, and obesity.⁵ Several studies have suggested that METS is associated with poor clinical outcome^{6, 7} and weakens the benefit of recanalization therapy in AIS.^{7, 8} The underlying mechanisms may involve impaired endogenous fibrinolytic capacity, endothelial dysfunction, inflammatory response, and hampered angiogenesis induced by METS.^{9, 10} Furthermore, neuroprotective mechanisms of RIPostC include modulation of microcirculation, endothelial function, oxidative stress, inflammation, neurogenesis, apoptosis, and autophagy.¹¹ Given the overlap of neuroprotective effects of RIPostC with the mechanisms underlying METS‐mediated damage on stroke, we hypothesize that METS may affect the efficacy of RIPostC in AIS. Therefore, this study was designed to investigate the association of METS with the efficacy of RIPostC in the RICAMIS trial.

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Remote Ischemic Conditioning and Outcomes in Acute Ischemic Stroke With Versus Without Large Artery Atherosclerosis

Remote ischemic conditioning on the limb is mostly done by healthcare professionals, using a manual blood-pressure cuff and a stopwatch. The standard RIC protocol, used in the majority of clinical trials, consists of four cycles of five minutes of inflation at 200mmHg, followed by five minutes of deflation.

Has your hospital been doing these for the past decade?

 

• leg compressions (25 posts to September 2015)

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Remote Ischemic Conditioning and Outcomes in Acute Ischemic Stroke With Versus Without Large Artery Atherosclerosis

Yu Cui,

Zhi-Mei Yuan,

Quan-Ying Liu,

Ying-Jia Wang and

Hui-Sheng Chen

Originally published18 Oct 2023https://doi.org/10.1161/STROKEAHA.123.045040Stroke. 2023;0

Abstract

BACKGROUND:

RICAMIS trial (The Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) has demonstrated efficacy of remote ischemic conditioning (RIC) in acute ischemic stroke. We conducted a post hoc analysis of RICAMIS to investigate whether large artery atherosclerosis (LAA) subtype contributed to the outcomes.

METHODS:

This is a post hoc analysis of the RICAMIS trial. Patients randomized to RIC group and Control group in full analysis set of RICAMIS were classified into LAA and non-LAA subtypes. The primary outcome was excellent functional outcome at 90 days, defined as modified Rankin Scale score of 0 to 1. Compared with patients receiving usual care, we investigated the association of RIC effect with outcomes in stroke subtypes and the interaction between RIC effect and stroke subtypes. The primary analysis was adjusted analysis.

RESULTS:

Among 1773 patients, 516 were assigned to LAA subtype (229 in the RIC group and 287 in the control group) and 1257 to non-LAA subtype (633 in the RIC group and 624 in the control group). Median age was 65 years, and 34.2% were women. A higher proportion of primary outcome was found to be associated with RIC treatment in LAA subtype (adjusted risk difference, 11.4% [95% CI, 3.6%–19.2%]; P=0.004), but not in non-LAA subtype (adjusted risk difference, 4.1% [95% CI, −1.1% to 9.3%]; P=0.12). There was no significant interaction between RIC effect and stroke subtypes (P=0.12).

CONCLUSIONS:

Patients with LAA subtype may benefit from RIC after stroke with respect to excellent functional outcome at 90 days.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03740971.

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A review of remote ischemic conditioning as a potential strategy for neural repair poststroke

And all this earlier research was not enough to realize that the next step was to create protocols on this rather than repeat research? So we had to waste more time and money better spent solving stroke problems?

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 A review of remote ischemic conditioning as a potential strategy for neural repair poststroke

Wantong Yu1| Changhong Ren1,2| Xunming Ji1,2This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.© 2022 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.Abbreviations: AIS, Acute ischemic stroke; Ang, Angiotensin; BDNF, brain-derived neurotrophic factor; CNS, central nervous system; eNOS, endothelial nitric oxide synthase; EPO, erythropoietin; GAP-43, growth-associated protein 43; HIF-1, Hypoxia inducible factor-1; iNOS, inducible nitric oxide synthase; LTD, long-term depression; LTP, long-term potentiation; mTOR, mammalian target of rapamycin; Ngb, neuroglobin; NO, nitric oxide; OPC, oligodendrocyte precursor cell; PSD95, Postsynaptic density protein-95; p- STAT3, signal transducer and activator of transcription 3 phosphorylation; RIC, Remote ischemic condition; STAT3, signal transducer and activator of transcription 3; SYN, Synaptophysin; Treg, regulatory T cell; VEGF, vascular endothelial growth factor; VEGFR, vascular endothelial growth factor receptor 2.1Department of Neurology and Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China2Center of Stroke, Beijing Institute for Brain Disorder, Capital Medical University, Beijing, ChinaCorrespondenceXunming Ji, Center of Stroke, Beijing Institute for Brain Disorder, Capital Medical University, Beijing 100069, China.Email: jixm@ccmu.edu.cnFunding informationNational Natural Science Foundation of China, Grant/Award Number: 81971114 and 81801313 

Abstract

Ischemic stroke is one of the major disabling health-care problem and multiple different approaches are needed to enhance rehabilitation, in which neural repair is the structural basement. Remote ischemic conditioning (RIC) is a strategy to trigger endogenous protect. RIC has been reported to play neuroprotective role in acute stage of stroke, but the effect of RIC on repair process remaining unclear. Several studies have discovered some overlapped mechanisms RIC and neural repair performs. This review provides a hypothesis that RIC is a potential therapeutic strategy on stroke rehabilitation by evaluating the existing evidence and puts forward some remaining questions to clarify and future researches to be performed in the fiel

Remote ischemic conditioning (RIC) with exercise (RICE) is safe and feasible for acute ischemic stroke (AIS) patients

 

And all this earlier research was not enough to realize that the next step was to create protocols on this rather than repeat research? So we had to waste more time and money better spent solving stroke problems?

• leg compressions (16 posts to September 2015)

  Remote ischemic conditioning (11 posts to July 2018)

   

• leg wraps (7 posts to May 2013)

   

Remote ischemic conditioning (RIC) with exercise (RICE) is safe and feasible for acute ischemic stroke (AIS) patients

Yanna Tong^1,2, Hangil Lee³, Wesley Kohls³, Zhenzhen Han^1,2, Honglian Duan^1,2, Zhe Cheng^1,2, Fenghai Li^1,2, Jie Gao^1,2, Jing Liu², Xiaokun Geng^1,2,3* and Yuchuan Ding^3*

• ¹Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
• ²Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
• ³Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States

Objective: Rehabilitation is essential in reducing stroke disability and should be performed as early as possible. Exercise is an established and effective rehabilitation method; however, its implementation has been limited as its very early use exacerbates cerebral injury and is restricted by patients' unstable conditions and disabilities. Remote ischemic conditioning (RIC) is a passive and accessible therapy in acute phases of stroke and appears to have similar neuroprotective effects as exercise. This study assessed the safety and feasibility of the novel rehabilitation strategy—early RIC followed by exercise (RICE) in acute ischemic stroke (AIS).

Methods: We conducted a single-center, double-blinded, randomized controlled trial with AIS patients within 24 h of stroke onset or symptom exacerbation. All enrolled patients were randomly assigned, at a ratio of 1:1, to either the RICE group or the sham-RICE group (sham RIC with exercise). Each group received either RIC or sham RIC within 24 h after stroke onset or symptom exacerbation, once a day, for 14 days. Both groups started the exercise routine on day 4, twice daily, for 11 total days. The safety endpoints included clinical deterioration, recurrence of stroke, hemorrhagic transformation, complications, and adverse events resulting from RICE during hospitalization. The efficacy endpoints [Modified Rankin Scale (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index, and walking ability] were evaluated at admission and 90 days after stroke onset.

Results: Forty AIS patients were recruited and completed the study. No significant differences in baseline characteristics were found between the two groups, which included risk factors, stroke severity at admission, pre-morbid disability, and other special treatments. No significant differences were found in the safety endpoints between two groups. Excellent recovery (mRS 0–2) at 3 months was obtained in 55% of the patients with RICE as compared 40% in sham group, but it did not reach a significant level.

Conclusions: RICE was safe and feasible for AIS patients, and seems to be a promising early stroke rehabilitation. The results of this study suggest a need for a future randomized and controlled multicenter trial with a larger sample size to determine the efficacy of RICE.