With the publication of results from the SERIC-IVT Trial, we performed an updated systematic review and meta-analysis by combining data from randomised controlled trials (RCTs) to assess the safety and efficacy of remote ischemic conditioning (RIC) in acute ischemic stroke (AIS) patients undergoing various therapies.

In AIS, timely reperfusion through thrombolysis or thrombectomy improves outcomes, but many patients remain with disability. Adjunct neuroprotective strategies like RIC, providing brief, repeated limb ischemia, can greatly help improve patient outcomes.

We searched PubMed, Cochrane Library, and ClinicalTrials.gov for RCTs fulfilling our inclusion criteria. The primary outcomes were an excellent 90-day functional outcome(mRS 0-1). Secondary outcomes included a favourable functional outcome(mRS 0-2), mortality, and cerebral hemorrhage. Statistical analysis was performed using R software.

13 RCTs (n=8397) were included. Compared to controls, the likelihood of achieving mRS 0–1 (RR 1.09; 95% CI 1.00–1.19; p = 0.0417) and mRS 0-2 (RR 1.04; 95% CI 1.01–1.08; p = 0.0053) was significantly higher in the intervention group. In contrast, 90-day mortality (RR 0.96; p = 0.67) and the rate of cerebral hemorrhage (RR 0.72; p = 0.54) did not differ significantly between the two groups. For stroke recurrence events, a trend toward reduced recurrence was observed in the intervention group; however, the difference was not statistically significant (RR 0.89; 95% CI 0.78–1.02; p = 0.0912). Subgroup analyses performed across patients receiving intravenous thrombolysis (IVT), mechanical thrombectomy (MT), mixed treatment, and medical therapy alone showed no statistically significant differences for any outcome.