Prevention of Ischemic Conditions in Non-disabling Stroke/Transient Ischemic Attack With Remote Ischemic Conditioning

This is a single-arm, open-labeled and phase II futility study. Application of Remote ischemic conditioning (RIC) as an adjunctive therapy to medication were involved in the study. RIC consisted of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on bilateral upper limbs twice a day. The study is to test whether RIC is effective in preventing ischemic evens after a minor ischemic stroke/transient ischemic attack within 3 months and to explore the safety and compliance of chronic RIC. Medication strategy is based on physician's best judgement.

Inclusion criteria

• Eighteen years old or older of any gender or race;
• Diagnosed with a non-cardiogenic MIS/TIA within 14 days; MIS is defined by an ischemic stroke of score of 3 or less on the NIHSS at the time of inclusion, TIA is defined as neurologic deficit attributed to focal brain ischemia, with symptoms resolution within 24 h of symptom onset, Symptom onset is defined by the "last see normal" principle;
• Stable vital signs, normal cardiac, hepatic and renal functions;
• Able to consent by himself/herself or by legally authorized representative.

Exclusion criteria

• Diagnosis of hemorrhage or other pathology, such as vascular malformation, tumor, abscess or other non-vascular diseases, based on brain CT or MRI;
• Modified Rankin Scale score > 2 at inclusion;
• Received iv. recombinant tissue plasminogen activator (rtPA) therapy or interventional treatment for the current event;
• Contradiction for aspirin or clopidogrel (known allergy, severe asthma or heart failure et al.) ;
• Clear indication for anticoagulation therapy ( cardiac source of embolus);
• Hemorrhagic tendency of any reason （including but not limit to Hemostatic disorder, platelet count <100 × 109/L, history of drug-induced hepatic dysfunction）;
• Any hemorrhagic transformation;
• Gastrointestinal bleed or major surgery within 3 months of symptoms onset;
• Stroke or TIA induced by interventional therapy or surgery;
• Any upper extremity soft tissue, vascular injury or peripheral blood vessel disease which may contraindicate RIC;
• Systolic blood pressure greater than 200 mmHg after medication;
• Planned revascularization (any angioplasty or vascular surgery) within the next 3 months ；
• Scheduled for surgery or interventional treatment requiring RIC cessation within next 3 months;
• Severe noncardiovascular comorbidity with life expectancy < 3 months;
• Pregnancy;
• Currently receiving an investigational drug or device by other studies.