Sex-Related Difference in Outcomes of Remote Ischemic Conditioning for Symptomatic Intracranial Atherosclerotic Stenosis

Remote ischemic conditioning (RIC) is a novel and promising therapeutic intervention for symptomatic intracranial atherosclerotic stenosis (sICAS). This study aimed to evaluate sex differences in stroke recurrence among patients with sICAS and assess the efficacy of RIC in the RICA (chronic remote ischemic conditioning in patients with symptomatic intracranial atherosclerotic stenosis) trial. The RICA trial was a multicenter, randomized clinical trial conducted across 84 stroke centers in China. Patients with sICAS were randomly assigned on a 1:1 ratio to receive either RIC intervention or sham RIC intervention once daily for 12 months. The primary endpoint was ischemic stroke recurrence. The median follow-up duration was 3.5 years. Of the 3,033 patients enrolled in the RICA trial, 1,079 (35.58%) were women. Female patients were generally older (mean [SD] age 62.9 [8.8] years versus 60 [9.2] years) and had a higher prevalence of hypertension, diabetes, and a higher body mass index than male patients. No significant difference was observed in ischemic stroke recurrence risk between female and male patients during a median follow-up of 3.5 years (20.5% versus 16.6%, adjusted hazard ratio, 1.18; [95% CI, 0.97 to 1.42]). However, RIC significantly reduced the risk of ischemic stroke recurrence in male patients, while no similar effect was observed in female patients (adjusted hazard ratio, 0.88; [95% CI, 0.58 to 1.32]; <i>P</i> for interaction = 0.379). No significant sex-based differences were observed in ischemic stroke recurrence among patients with sICAS over the 3.5-year follow-up period. RIC may have better therapeutic benefits for male patients with good compliance.