{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T01:47:56Z","timestamp":1792979276571,"version":"4.5.0"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,10,3]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, \u2264200 mm Hg [n\u2009=\u2009749] and sham cuff pressure, 20 mm Hg [n\u2009=\u2009751]). 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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,\n P<\/jats:italic>\n \u2009=\u2009.67; absolute difference in median mRS score, \u22121; \u22121.7 to \u22120.25). 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;\n P<\/jats:italic>\n \u2009=\u2009.68). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03481777<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.16893","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T11:02:19Z","timestamp":1696330939000},"page":"1236","source":"Crossref","is-referenced-by-count":95,"title":["Remote Ischemic Conditioning for Acute Stroke"],"prefix":"10.1001","volume":"330","author":[{"given":"Rolf Ankerlund","family":"Blauenfeldt","sequence":"first","affiliation":[{"name":"Danish Stroke Center, Department of Neurology, Aarhus 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