Long-term efficacy of remote ischaemic postconditioning after rt-PA intravenous thrombolysis in patients with acute ischaemic stroke

Objectives To evaluate the long-term efficacy of remote ischaemic postconditioning (RIPC) on functional outcomes in patients with acute ischaemic stroke (AIS) who received intravenous thrombolysis (IVT). Design This was a post-trial follow-up study of a rater-blinded randomised controlled trial. Setting Single-centre study conducted in a tertiary hospital in China, with follow-up interviews performed via telephone approximately 4.8 years after randomisation (November 2022). 

Participants. The original trial (NCT03218293) included 68 patients allocated either to the control group (n=34) or the RIPC group (n=32) between August 2017 and June 2018. For this follow-up, 62 patients (93.9%) were successfully contacted and included in the analysis. 

Primary and secondary outcomes. The primary outcome was the proportion of patients achieving a favourable functional outcome, defined as a modified Ranking Score (mRS) 0 or 1 at long-term follow-up. Secondary outcomes included functional independence (mRS 0–2), recurrent stroke/transient ischaemic attack (TIA) and all-cause mortality. Binary outcomes were analysed using generalised linear models with inverse probability of treatment weighting (IPTW) adjustment. Time-to-event analyses employed IPTW-weighted Kaplan-Meier curves and Cox proportional hazards models, with statistical significance set at p<0.05. 

Results. At a median follow-up of 4.8 years (IQR 4.6–5.1), the proportion of favourable functional outcome was higher in the RIPC group when compared with the control group (unadjusted risk ratio, 3.87; 95% CI 1.34 to 11.17; p=0.012 and IPTW-adjusted risk ratio, 5.92; 95% CI 1.45 to 24.24; p=0.017). The RIPC group also showed a trend towards improved stroke/TIA recurrence-free survival compared with the control group (IPTW-adjusted HR, 0.52; 95% CI 0.06 to 1.00; p=0.050). 

Conclusion. IVT combined with repeated in-hospital RIPC may lead to improved long-term functional recovery and reduced stroke/TIA recurrence in patients with AIS. Larger multicentre trials are warranted to confirm these findings.