Abstract | Keywords | Export | Availability | Bookmark

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Background Acute ischemic stroke (AIS) is a prevalent disease with a large mortality, morbidity and socioeconomic cost. Current treatment of AIS in the acute phase focusses on revascularization strategies. Due to a short window of opportunity and stringent inclusion criteria, only a small number of patients can benefit from these reperfusion therapies. Although neuroprotective strategies could theoretically be a meaningful intervention, possibly even in the prehospital setting, studies have been disappointing. Preclinical studies have shown that remote ischemic conditioning (RIC), i.e. induction of intermittent ischemia, typically applied to the limbs, may reduce infarct volume and improves neurological deficits in experimental stroke. Aim The aim of this study is to describe and summarize all the clinical evidence on the efficacy and safety of RIC in the treatment of AIS. Methods A study of the literature on RIC and AIS was conducted on Pubmed, EMBASE, Web of science core collection and Cochrane central databases. The included randomized controlled trials (RCT) were assessed for methodological quality, and outcomes reported on efficacy and safety summarized and analyzed in a narrative analysis. Data on frequency of stroke recurrence and favorable clinical outcome, defined as the percentage of patients with modified Rankin Score (mRS) ≤ 1 at day 90, were extracted and pooled in a quantitative meta-analysis. Relative risks with 95% confidence intervals were calculated. Data was pooled with a random-effect model and presented as a forest plot. I² was used to assess for heterogeneity. Results We included 16 published RCT’s and 15 ongoing trials in our study. All the evidence suggests that RIC is a safe intervention, even if administered in combination with revascularization techniques. Outcomes reported on efficacy were not unambiguous. 14 RCT’s were included for meta-analysis. The total relative risk for favorable clinical outcome at 90 days was 1.25 (95%CI 0.98-1.58, P=0.07, N=8, n=780, I²=66%) in favor of RIC treatment. The total relative risk for stroke recurrence was 0.39 (95%CI 0.21-0.72, P=0.003, N=10, n=539, I²=0%) in favor of RIC treatment. Subgroup analysis revealed that a more extensive RIC regimen produces more favorable results with regard to functional and neurological functioning. Conclusion In this meta-analysis, we found low-quality evidence that RIC may have a beneficial effect on functional outcome and reduces stroke recurrence. RIC proves to be a safe intervention. The large heterogeneity in timing, number, duration, or repetition of RIC limits the ability to draw definitive conclusions on efficacy and propose a treatment regimen. Larger RCT’s are warranted.