Remote Ischemic Conditioning for Acute Stroke: The RESIST Randomized Clinical Trial.

Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke.
To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke.
This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023).
The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, ≤200 mm Hg [n = 749] and sham cuff pressure, 20 mm Hg [n = 751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants.
The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke.
Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20, P = .67; absolute difference in median mRS score, -1; -1.7 to -0.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11; P = .68). Upper extremity pain during treatment and/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group.
RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke.
ClinicalTrials.gov Identifier: NCT03481777.

Author

admin

View all posts

Remote Ischemic Conditioning for Acute Stroke: The RESIST Randomized Clinical Trial.

REFERENCES & ADDITIONAL READING

ABOUT THE EXPERTS

PW Weekly Newsletters

RECENT ARTICLES

#VisualAbstract Sebetralstat Provides Faster Symptom Relief and Reduced Severity in Hereditary Angioedema Attacks

CME/CE: Virtual Reality Reduces Chest Tube Removal Pain During Cardiac Surgery

Post-Transcatheter Edge-to-Edge Repair Repeat Mitral Valve Intervention Shows Promise in Reducing Heart Failure Hospitalizations

Daratumumab Shows Promise for Systemic Lupus Erythematosus Treatment

Preserflo MicroShunt Bests XEN45 Gel Stent at Lowering IOP Post-Filtering Surgery for Advanced Glaucoma

Early, Targeted Cellular Immune Response Appears Beneficial in COVID-19

PODCAST

Caring for Colleagues & Their Children, Part 1: Setting Expectations

Embracing Whole-Person Health for Physician & Patient Wellness

AI Diagnostics, Private Equity in Your Practice

PW Weekly Newsletters

RELEVANT ARTICLES FOR YOU

Daratumumab Shows Promise for Systemic Lupus Erythematosus Treatment

Preserflo MicroShunt Bests XEN45 Gel Stent at Lowering IOP Post-Filtering Surgery for Advanced Glaucoma

Early, Targeted Cellular Immune Response Appears Beneficial in COVID-19

P. aeruginosa Infection Rates Elevated in Lung Transplant Recipients With Robust DSA Response

Small Protein Targeting IL-17A Effective in Psoriatic Arthritis

Uric Acid Levels Do Not Correlate With Erectile Dysfunction

Factors Boosting Corneal Edema Risk Post-Cataract Surgery

Ophthalmologic Manifestations of Acute Leukemia Are Heterogeneous, Detectable at Initial Presentation or Relapse

Cytokine Adsorber CS Effectively Removes Myoglobin in Patients With Rhabdomyolysis

PODCAST

Caring for Colleagues & Their Children, Part 1: Setting Expectations

Embracing Whole-Person Health for Physician & Patient Wellness

AI Diagnostics, Private Equity in Your Practice

Follow Us

Remote Ischemic Conditioning for Acute Stroke: The RESIST Randomized Clinical Trial.

Author

REFERENCES & ADDITIONAL READING

ABOUT THE EXPERTS

PW Weekly Newsletters

EXPLORE MORE

RECENT ARTICLES

PODCAST

PW Weekly Newsletters

RELEVANT ARTICLES FOR YOU

PODCAST

Stay connected to the latest news with Physician’s Weekly