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Ultra-early RIPC does not significantly improve 90-day functional independence in acute ischemic strokeEarly pressure cuff treatment shows no benefit for stroke recovery

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Key Takeaway
Note that ultra-early RIPC is safe but does not improve 90-day functional independence in acute ischemic stroke.

This randomized controlled trial enrolled 270 adults with acute ischemic stroke due to large vessel occlusion who presented within 24 hours of symptom onset and underwent successful EVT recanalization. The study was conducted across 8 hospitals in China.

Patients were assigned to either ultra-early RIPC or guideline-based therapy alone. The RIPC intervention involved pneumatic devices providing 5 cycles of bilateral upper-arm cuff inflation at 180 mm Hg for 5 minutes followed by 3 minutes deflation, performed for 7 days.

The primary outcome was functional independence at 90 days (modified Rankin Scale score of 0 to 2). In the RIPC group, 81/133 (60.9%) achieved functional independence compared to 78/135 (57.8%) in the control group. The adjusted risk ratio was 1.07 (95% CI, 0.89-1.30), indicating no statistically significant difference between groups.

Safety assessments reported that RIPC was tolerated well, with 10 of 133 (7.5%) patients in the RIPC group experiencing adverse events compared to 0 in the control group. However, serious adverse events and discontinuation rates were not reported. While ultra-early RIPC is safe, it does not significantly improve 90-day functional outcomes in this population.

When someone suffers a major stroke, every moment counts. Doctors often look for extra ways to help the brain heal after a blockage is cleared. One method being explored is ultra-early RIPC, which uses pneumatic cuffs to apply pressure to the arms shortly after the stroke occurs.

A trial involving 270 adults in China tested this method against standard care. The researchers looked at whether these pressure cycles helped patients regain their independence three months later. While the treatment was reported as safe for those who received it, the results showed no significant difference in recovery compared to standard care alone.

The study found that about 61% of people using the cuffs achieved functional independence, while about 58% of those receiving standard care reached the same goal. Because the numbers were so close, the extra step of using pressure cuffs did not provide a measurable boost in long-term outcomes for these patients.

What this means for you:
Early use of pneumatic arm cuffs is safe but does not improve functional independence after a major stroke.

Common questions

Does this treatment help people recover from a stroke?

The study found no significant difference in recovery. About 60.9% of patients using the pressure cuffs achieved functional independence at 90 days, while 57.8% of those receiving standard care reached the same goal. Because these results are so similar, the extra treatment did not provide a measurable improvement.

Is the use of pneumatic cuffs safe for stroke patients?

The study reported that the treatment was safe. In the group using the pressure cuffs, 10 out of 133 people experienced an adverse event. However, no serious adverse events were reported, and the procedure was considered tolerable for the patients involved.

Who was included in this study?

The trial included 270 adults who suffered a major stroke due to a large vessel occlusion. These patients arrived at the hospital within 24 hours of their symptoms starting and underwent a successful procedure to clear the blockage.

Study Details

Study typeRct
Sample sizen = 135
EvidenceLevel 2
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Although the neuroprotective potential of remote ischemic postconditioning (RIPC) has been reported, the efficacy and safety of ultra-early RIPC administered after endovascular treatment (EVT) in patients with acute ischemic stroke remain unclear. This study evaluated the efficacy and safety of ultra-early RIPC in patients with acute ischemic stroke undergoing EVT. METHODS: The EnTRIPS trial (Endovascular Treatment Combined With Remote Ischemic Postconditioning in Patients With Acute Ischemic Stroke) was a multicenter, randomized, controlled, outcome assessor-blinded, prospective clinical trial. The trial was conducted at 8 hospitals in China between April 12, 2021, and March 26, 2025. Eligible patients were adults with acute ischemic stroke due to large vessel occlusion who presented within 24 hours of symptom onset, underwent EVT, and achieved successful recanalization. A total of 270 eligible patients were randomized within 6 hours after EVT to receive either RIPC plus guideline-based therapy (n=135) or guideline-based therapy alone (n=135). RIPC was administered for 7 days using pneumatic devices consisting of 5 cycles of bilateral upper-arm cuff inflation (5 minutes at 180 mm Hg) followed by deflation (3 minutes). The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2 (range, 0 [no symptoms] to 6 [death]). Safety outcomes included the incidence of RIPC-related adverse events within 7 days. RESULTS: Among 270 randomized patients, a total of 268 (99.3%) participants completed the trial, including 133 in the RIPC group and 135 in the control group (mean [SD] age, 65.5 [16.8] years; 171 [63.8%] men). At 90 days, functional independence was achieved in 81 (60.9%) patients in the RIPC group and 78 (57.8%) patients in the control group (adjusted risk ratio, 1.07 [95% CI, 0.89-1.30]; =0.46). RIPC-related adverse events occurred in 10 of 133 (7.5%) patients, and no intervention-related adverse events occurred in the control group. CONCLUSIONS: Ultra-early RIPC is safe for patients with acute ischemic stroke treated with EVT, but it does not significantly improve the 90-day functional outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04581759.
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