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Blauenfeldt RA, Mortensen JK, Hjort N, Valentin JB, Homburg AM, Modrau B, Sandal BF, Gude MF, Berhndtz AB, Johnsen SP, Hess DC, Simonsen CZ, Andersen G. Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial. Stroke 2024; 55:874-879. [PMID: 38299363 PMCID: PMC10962424 DOI: 10.1161/strokeaha.123.046144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Remote ischemic conditioning (RIC) is a simple and noninvasive procedure that has proved to be safe and feasible in numerous smaller clinical trials. Mixed results have been found in recent large randomized controlled trials. This is a post hoc subgroup analysis of the RESIST trial (Remote Ischemic Conditioning in Patients With Acute Stroke), investigating the effect of RIC in different acute ischemic stroke etiologies, and whether an effect was modified by treatment adherence. METHODS Eligible patients were adults (aged ≥18 years), independent in activities of daily living, who had prehospital stroke symptoms with a duration of less than 4 hours. They were randomized to RIC or sham. The RIC treatment protocol consisted of 5 cycles with 5 minutes of cuff inflation alternating with 5 minutes with a deflated cuff. Acceptable treatment adherence was defined as when at least 80% of planned RIC cycles were received. The analysis was performed using the entire range (shift analysis) of the modified Rankin Scale (ordinal logistic regression). RESULTS A total of 698 had acute ischemic stroke, 253 (36%) were women, and the median (interquartile range) age was 73 (63-80) years. Median (interquartile range) overall adherence to RIC/sham was 91% (68%-100%). In patients with a stroke due to cerebral small vessel disease, who were adherent to treatment, RIC was associated with improved functional outcome, and the odds ratio for a shift to a lower score on the modified Rankin Scale was 2.54 (1.03-6.25); P=0.042. The association remained significant after adjusting for potential confounders. No significant associations were found with other stroke etiologies, and the overall test for interaction was not statistically significant (χ2, 4.33, P=0.23). CONCLUSIONS In patients with acute ischemic stroke due to cerebral small vessel disease, who maintained good treatment adherence, RIC was associated with improved functional outcomes at 90 days. These results should only serve as a hypothesis-generating for future trials. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481777.
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Affiliation(s)
- Rolf Ankerlund Blauenfeldt
- Department of Neurology, Aarhus University Hospital, Denmark (R.A.B., J.K.M., N.H., C.Z.S., G.A.)
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
| | - Janne Kaergaard Mortensen
- Department of Neurology, Aarhus University Hospital, Denmark (R.A.B., J.K.M., N.H., C.Z.S., G.A.)
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
| | - Niels Hjort
- Department of Neurology, Aarhus University Hospital, Denmark (R.A.B., J.K.M., N.H., C.Z.S., G.A.)
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
| | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Denmark (J.B.V., S.P.J.)
| | - Anne-Mette Homburg
- Department of Neurology, Research Unit for Neurology, Odense University Hospital, Denmark (A.-M.H.)
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Denmark (B.M.)
| | | | - Martin Faurholdt Gude
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark (M.F.G.)
| | - Anne Brink Berhndtz
- Department of Neurology, Regional Hospital Gødstrup, Denmark (B.F.S., A.B.B.)
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Denmark (J.B.V., S.P.J.)
| | - David C. Hess
- Department of Neurology, Medical College of Georgia, Augusta University, GA (D.C.H.)
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (R.A.B., J.K.M., N.H., C.Z.S., G.A.)
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Denmark (R.A.B., J.K.M., N.H., C.Z.S., G.A.)
- Department of Clinical Medicine, Aarhus University, Denmark (R.A.B., J.K.M., N.H., M.F.G., C.Z.S., G.A.)
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