Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke

作者：Dawei Chen, Yu Cui, Xiaoqiu Li, Xinhong Wang, Yu-Tong Ma, Yong Zhao, Jing Han, Chang-Qing Deng, Mei Hong, Ying Bao, Li-Hong Zhao, Ting-Guang Yan, Ren-Lin Zou, Hui Wang, Zhuo Li, Li-Shu Wan, Li Zhang, Lian-Qiang Wang, Liyan Guo, Ming-Nan Li, Dongqing Wang, Qiang Zhang, Da-Wei Chang, Hongli Zhang, Jing Sun, Chong Meng, Zai-Hui Zhang, Liying Shen, Li Ma, Gui-Chun Wang, Run-Hui Li, Ling Zhang, Cheng Bi, Liyun Wang, Duolao Wang, RICAMIS Investigators, Shi-Mei Geng, Jing Shi, Ming Sun, Xiaofeng Qiu, Haitao Jiang, Yujie Zhang, Jingyang Chen, Ruiping Wang, Fusheng Bai, Jing Li, Xiaohui Gong, Ying Bai, Yansong Li, Ye-Fang Feng, Chong Ha, Changhao Jiang, Jin-Hua Zhai, Bing Han, Ye Wang, Dong‐Yu Wang, Kui-Hua Yang, Haiyan Yu, Xiu-Kun Yu, Hong‐Bo Xiao, Chun Nie, Zhen Jiao, Jingyu Li, Zhao-Min Meng, Shao-Yuan Chen, Xiao-Hong Song, Jun Xu, Li Li, Xiaoling Wang, Xiaojie Wang, Wen-Xiang Zheng, Wenxu Zheng, Yajun Liu, Min Yu, Juan Feng · 发表于：JAMA · 年份：2022 · DOI：10.1001/jama.2022.13123 · 被引用次数：185 · 研究领域：Cardiac Ischemia and Reperfusion、Neurological Disease Mechanisms and Treatments、Acute Ischemic Stroke Management

Importance: Preclinical and clinical studies have suggested a neuroprotective effect of remote ischemic conditioning (RIC), which involves repeated occlusion/release cycles on bilateral upper limb arteries; however, robust evidence in patients with ischemic stroke is lacking. Objective: To assess the efficacy of RIC for acute moderate ischemic stroke. Design, Setting, and Participants: This multicenter, open-label, blinded-end point, randomized clinical trial including 1893 patients with acute moderate ischemic stroke was conducted at 55 hospitals in China from December 26, 2018, through January 19, 2021, and the date of final follow-up was April 19, 2021. Interventions: Eligible patients were randomly assigned within 48 hours after symptom onset to receive treatment with RIC (using a pneumatic electronic device and consisting of 5 cycles of cuff inflation for 5 minutes and deflation for 5 minutes to the bilateral upper limbs to 200 mm Hg) for 10 to 14 days as an adjunct to guideline-based treatment (n = 922) or guideline-based treatment alone (n = 971). Main Outcomes and Measures: The primary end point was excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. All end points had blinded assessment and were analyzed on a full analysis set. Results: Among 1893 eligible patients with acute moderate ischemic stroke who were randomized (mean [SD] age, 65 [10.3] years; 606 women [34.1%]), 1776 (93.8%) completed the trial. The number with excel...