ABSTRACT NUMBER: ESOC2026A2328 NEUROPROTECTIVE EFFECT OF REMOTE ISCHEMIC CONDITIONING IN ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY—PROTECT-I TRIAL

Abstract Background and aims Endovascular treatment (EVT) improves outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO); however, more than half of patients still experience poor functional outcome. Remote ischemic conditioning (RIC), consisting of brief cycles of limb ischemia and reperfusion, has shown neuroprotective effects in preclinical studies, but clinical evidence—particularly in the EVT setting—remains limited. We investigated whether RIC reduces final infarct volume expressed as a percentage of the baseline perfusion lesion in AIS patients undergoing EVT. Methods PROTECT-I was a randomized, open-label, single-center trial with blinded endpoint assessment. AIS patients with anterior circulation LVO eligible for EVT were randomized (1:1) to RIC plus standard care or standard care alone. RIC consisted of four 5-minute cycles of upper-limb ischemia (200 mmHg) followed by reperfusion. MRI was performed at baseline and at Day 1. The primary outcome was final infarct volume on Day-1 diffusion-weighted imaging, expressed as a percentage of the baseline perfusion lesion defined by Tmax≥6 s. Results The intention-to-treat population included 130 patients (mean age 72.6 ± 15 years; 55.4% male). Median final infarct volume relative to baseline perfusion lesion was 0.311 [0.135–0.565] in the RIC group and 0.278 [0.116–0.610] in the control group. After dichotomization at the median (0.298), RIC was not associated with reduced infarct volume (OR 1.30, 95% CI 0.61–2.79; P = 0.50). Results remained nonsignificant after adjustment for final TICI score. Conclusions RIC did not reduce final infarct volume expressed as a percentage of the baseline perfusion lesion in AIS patients treated with EVT. Conflict of interest Laura Mechtouff: nothing to disclose; Alexandre Bani-Sadr: nothing to disclose; Omer Faruk Eker: nothing to disclose; Julia Fontaine: nothing to disclose; Paul Clottes:: nothing to disclose; Baptiste Balanca: nothing to disclose; Yves Berthezene: nothing to disclose; Norbert Nighoghossian: nothing to disclose; Nathan Mewton: nothing to disclose; Tae-Hee Cho: nothing to disclose. Figure 1 - belongs to Conclusions