{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:38:49Z","timestamp":1786113529519,"version":"build-2736575974"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Rapid local ischemic postconditioning may protect the brain after acute ischemic stroke, but its safety and optimal dosing in successfully reperfused patients after mechanical thrombectomy remain undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This investigator-initiated, prospective, adaptive, multicenter phase I single-arm dose-finding trial employed a Bayesian Optimal Interval (Bayesian Optimal Interval Phase I\/II) design. Patients with anterior circulation large-vessel occlusion and modified Thrombolysis in Cerebral Infarction 2b\/3 reperfusion were enrolled without randomization. Within 5 minutes of recanalization, rapid local ischemic postconditioning was delivered via a balloon-guiding catheter positioned at the ipsilateral C1\u2013intracranial internal carotid artery, alternating inflation\/deflation to interrupt antegrade flow. Six dose levels were prespecified by inflation\/deflation durations and cycles: 15\/15s \u00d75; 1\/1, 2\/2, 3\/3, 4\/4, and 5\/5 minutes \u00d74. The dose-limiting toxicity (including malignant infarction, procedure-related complications requiring treatment, or other procedure-attributable serious adverse events) threshold was 15%. The efficacy target (absence of infarct growth &gt;10 mL at 72 hours) was 60%. Doses were eliminated if the posterior probability that toxicity exceeded 15% was \u22650.95 or efficacy &lt;60% was \u22650.90. The dose with the highest utility meeting these criteria was selected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Five cohorts (n=25, 5 each) were enrolled. Four cohorts received 2\/2 minutes\u00d74 (n=20): 14 met the efficacy end point (posterior probability true efficacy &lt;60%, \u22480.15), and 1 had a dose-limiting toxicity due to large infarction growth (probability true toxicity &gt;15%, \u22480.16). One cohort received 3\/3 minutes\u00d74 (n=5): 3 met the efficacy end point (probability true efficacy &lt;60%, \u22480.31) and 2 had dose-limiting toxicities due to large infarction growth (probability true toxicity &gt;15%, \u22480.95). This triggered the predefined safety rule, preventing further testing at 3\/3-minute and higher doses. Bayesian Optimal Interval Phase I\/II selected 2\/2 minutes\u00d74 as the optimal regimen with a favorable efficacy-toxicity profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Rapid local ischemic postconditioning initiated immediately after thrombectomy was feasible. The 2\/2 minutes\u00d74 regimen met prespecified safety and efficacy thresholds and warrants evaluation in a larger, definitive trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT06526429.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055708","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:00:13Z","timestamp":1778490013000},"page":"1950-1959","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Safety of Rapid Local Ischemic Postconditioning After Thrombectomy in Acute Stroke: A Dose-Finding Trial (RAPID SAVE)"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct06526429","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2996-5979","authenticated-orcid":true,"given":"Jiangshan","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Radiology (J.D., Y.T., G.H., L.W., H.L., Y.Z.), Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China."},{"name":"Department of Neurology (J.D.), Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3110-5844","authenticated-orcid":true,"given":"Tingyu","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yining","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.D., Y.T., G.H., L.W., H.L., Y.Z.), Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2043-7202","authenticated-orcid":true,"given":"Guangchen","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.D., Y.T., G.H., L.W., H.L., Y.Z.), Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.D., Y.T., G.H., L.W., H.L., Y.Z.), Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao 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