The effect of repeated remote ischaemic postconditioning on infarct size in stroke patients.

Objective: To examine the impact of remote ischaemic postconditioning after an ischaemic stroke on infarct size and clinical outcome in patients, but also to better understand the potential underlying mechanisms contributing to these effects.



Study design: Randomized single blind placebo-controlled clinical trial



Study population: 200 patients with ischaemic stroke who are being admitted to the emergency room of the Radboudumc.



Intervention: Remote RIPostC: 4 cycles of ischaemia of the arm by inflating a simple blood pressure cuff around the upper arm at 20 mmHg above systolic blood pressure during 5 minutes followed by 5 minutes of reperfusion. This will be performed twice a day during the complete duration of hospitalization.



Main study parameters/endpoints: Difference in final infarct size between the intervention and control group. Infarct size will be measured using MRI. This primary outcome will be linked to our secondary outcomes: Clinical outcome and vascular, immune, and anti-inflammatory pathways.

The hypothesis is that repeated remote ischaemic postconditioning (by improving vascular, immune and anti-inflammatory pathways) will minimize infarct size and, subsequently, will improve clinical outcome in stroke patients.

Day of stroke: Baseline measurements for markers of vasculari, immune and anti-inflammatory pathways. informed consent.



Day1-4: Intervention twice daily.



Four days past stroke or at the end of hospitalization: Infarct size, blood sampling, clinical outcome in acute setting (NIHSS)



Twelve weeks: Clinical outcome (modified ranking score), Quality of life (SS-QoL)



Twelve months: Clinical outcome (modified ranking score), hospitalization, morbidity and mortality.

Repeated remote ischaemic postconditioning (RIPostC): 4 cycles of ischaemia of the arm by inflating a blood pressure cuff around the upper arm at 20 mmHg above systolic blood pressure during 5 minutes followed by 5 minutes of reperfusion. This procedure will be performed twice a day (morning and afternoon) during the complete duration of hospitalization after the ischaemic stroke. The intervention will be administered by a trained researcher.