ABSTRACT NUMBER: ESOC2026LB143 REMOTE ISCHAEMIC CONDITIONING FOR ACUTE ISCHAEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY (RECAST-MT): A PRE-SPECIFIED INTERIM ANALYSIS OF A RANDOMIZED, PHASE III CLINICAL TRIAL

Abstract Background and aims Remote ischaemic conditioning (RIC) has been shown to be safe and potentially beneficial in patients with acute ischaemic stroke (AIS); however, its efficacy in patients undergoing mechanical thrombectomy (MT) remains uncertain. We investigated whether adjunctive RIC improves the functional outcomes in patients with AIS treated with MT. Methods RECAST-MT is a multicentre, randomised, controlled, open-label trial with blinded end-point assessment conducted in China. Patients with AIS due to anterior circulation large-vessel occlusion scheduled for MT were randomly assigned (1:1:1) to receive 14-day RIC, 30-day RIC, or standard treatment alone. RIC was delivered by intermittent inflation of upper-arm cuffs to 200 mmHg, initiated before recanalization and continued for 14 or 30 days thereafter. A pre-specified interim analysis was planned to allow early termination for futility. The primary end point is functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days. Results From September 23, 2024, to December 2, 2025, 786 patients were randomised and included in this pre-specified interim analysis, with 262 assigned to each group. The mean age was 68.0 years, 251 (31.9%) were female, 697 (88.7%) had a baseline NIHSS score of 6–20, and 703 (89.4%) were randomised within 12 hours of symptom onset. Trial recruitment and follow-up are ongoing. The interim analysis follow-up will be completed by March 2026, and detailed results will be presented at the ESOC2026. Conclusions The RECAST-MT trial is designed to determine whether adjunctive RIC improves functional outcomes in patients with AIS undergoing MT. ClinicalTrials.gov: NCT06559241. Conflict of interest