Meta-analysis finds remote ischemic conditioning modestly improves functional independence in acute ischemic stroke

BackgroundRecent large-scale randomized controlled trials (RCTs) regarding remote ischemic conditioning (RIC) for acute ischemic stroke (AIS) have yielded inconsistent results. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RIC, with a focused analysis on the impact of treatment duration and reperfusion strategies.MethodsWe searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 30, 2026, for eligible RCTs comparing RIC with control in AIS patients; reference-list screening and supplementary Google Scholar searches were also performed. The primary outcome was functional independence (Modified Rankin Scale score 0–2) at 90 days. The secondary outcome was 90-day mortality. Exploratory subgroup analyses were performed according to treatment duration (longer-duration vs. shorter-duration) and reperfusion context (endovascular thrombectomy [EVT], intravenous thrombolysis [IVT], and non-reperfusion/mixed standard-care contexts). Risk Ratios (RRs) were calculated using a random-effects model.ResultsA total of 12 RCTs involving 5,301 patients were included. Overall, RIC was associated with a modest but statistically significant increase in the rate of functional independence at 90 days (RR 1.05, 95% CI 1.01–1.09; p = 0.01). Exploratory subgroup analyses suggested that longer-duration RIC protocols (≥5 days) may be associated with more favorable outcomes (RR 1.08), whereas shorter-duration protocols did not show a clear signal of benefit (RR 1.03). Similarly, a potential benefit was observed in patients undergoing EVT (RR 1.25, 95% CI 1.07–1.46; p = 0.005), whereas no additional benefit was evident in patients receiving IVT alone (RR 0.99; p = 0.82). No significant difference in 90-day mortality was observed between groups (RR 0.99; p = 0.94). Sensitivity analyses were broadly consistent with the primary result; however, exclusion of the largest trial attenuated the pooled effect and rendered it no longer statistically significant.ConclusionRIC appears to be a safe adjunctive therapy for AIS and may offer a modest functional benefit. The available evidence suggests, but does not prove, that longer treatment regimens and use in patients undergoing mechanical thrombectomy may be associated with more favorable outcomes. These subgroup findings should be interpreted cautiously and confirmed in future high-quality trials.