Abstract Body: The treatment strategy for acute ischemic stroke (AIS) is reperfusion. In addition, neuroprotective measures have influenced outcomes in mortality, morbidity, and disability. Remote ischemic conditioning (RIC) is a neuroprotective measure that minimizes ischemic reperfusion injury to the target organ. Previous trials have showed its safety and efficacy, but its impact to vascular cognitive impairment and quality of life is undermined. This study aimed to demonstrate its efficacy and impact in terms of disability, cognitive impairment, and quality of life.

This is a single center, open-label trial conducted in a tertiary center in the Philippines which included 104 patients randomized to RIC (n=52) and control (n=52) groups. One dose of RIC comprised of 4 cycles of BP cuff inflation 20mmHg above baseline systolic blood pressure (ceiling of 180mmHg) for 5 minutes followed by 5 minutes of cuff deflation; a total of 8 doses of RIC were given over four days with 12 hour intervals. The control arm did not receive cuff inflations; both groups received guideline-based standard stroke care.

Out of 104 patients, 10 (9.6%) were excluded from full analysis; 6 patients were excluded due to mortality, while 4 patients failed to undergo MOCA-P and HRQoL testing due to severe aphasia. RIC procedure was completed according to the study protocol in all enrolled 52 patients.

Both groups had similar baseline clinical and radiologic findings. NIHSS scores across admission, 24 hours, and discharge timepoints show significant change in the RIC group, while the control group only showed significant NIHSS change between the admission and 24 hour timepoints. The mean MOCA-P scores are 26.5 for RIC group vs control group (25.9). Subgroup analysis for MOCA-P classification showed that RIC group had more normal scores (70.8%) vs control group (65.2%). The control group also had more patients under moderate/severe scores (6.4%). The mean HRQoL score at 90 days for RIC group was 90.6 vs 84.7 for control group. Subgroup analysis showed that the RIC group had a mean pain score of 92.5 vs control group 78.7, which was statistically significant (p<0.01).

Remote ischemic conditioning in acute ischemic stroke reduced stroke severity during admission, and increased the likelihood of better quality of life at 90 days. The prevalence of cognitive impairment was more evident in patients who did not receive RIC, but these findings require replication in a larger trial to prove its statistical power.