ABSTRACT NUMBER: ESOC2026A1281 EVALUATING REMOTE ISCHEMIC CONDITIONING AS A SECONDARY PREVENTION METHOD IN CEREBROVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Remote ischemic conditioning (RIC) is a promising non-pharmacological and non-invasive therapy for cerebrovascular disease involving brief cycles of ischemia and reperfusion. This systematic review and meta-analysis evaluated the efficacy of RIC for secondary prevention in stroke and other cerebrovascular diseases. Methods MEDLINE, Embase, and Web of Science were searched from inception to December 9, 2025. Randomized controlled trials with adult participants diagnosed with cerebrovascular disease were included. The primary outcome was cerebral hemodynamics. Secondary outcomes included new cerebral infarcts, stroke occurrence, functional and cognitive measures. Forest plots were generated using standardized mean differences (SMD) for continuous data and odds ratios (OR) for binary outcomes. Results Eighteen studies (4,116 patients) were included. In stroke and cerebral small vessel dsiease patients, RIC improved middle cerebral artery (MCA) mean velocity beyond 90 days (SMD:0.79; n=4 studies) but not MCA pulsatility index (SMD:-0.20; n=3). NIHSS (SMD:-0.93; n=2), mRS (SMD:-0.65; n=2), and MoCA (SMD:0.60; n=3) scores beyond 90 days favoured RIC. While white matter hyperintensity (WMH) volume did not significantly improve with RIC use (SMD:0.01; n=4), RIC reduced new cerebral infarcts in stroke patients after 90 days (OR:0.25; n=2). Patients with extra/intra-cranial atherosclerosis or Moyamoya disease who received RIC were less likely to experience a stroke after 90 days (OR:0.23; n=4). Conclusions RIC can improve cerebral hemodynamics, improve neurological and cognitive outcomes, and reduce new infarcts across cerebrovascular diseases. However, the strength of these findings is limited by a small number of study for certain outcomes and methodological heterogeneity. Conflict of interest Kaden Lam: Nothing to disclose; Bogna Anna Drozdowksa: Nothing to disclose; Ryan Rosentreter: has a patent (US 17/317,771) for a system for prehospital patient monitoring/assessment and delivery of remote ischemic conditioning or other cuff-based therapies; William Betzner: Nothing to disclose; Jianhai Zhang: Nothing to disclose; Carlos Camara-Lemarroy: Nothing to disclose; Zahinoor Ismail: Nothing to disclose; Eric E. Smith: Nothing to disclose; Aravind Ganesh: has a patent (US 17/317,771) for a system for prehospital patient monitoring/assessment and delivery of remote ischemic conditioning or other cuff-based therapies