Remote ischaemic conditioning for acute moderate posterior ischaemic stroke (RICAMIS2): rationale and design

Rationale Remote ischaemic conditioning (RIC) represents a novel neuroprotective intervention. Findings from the RIC for Acute Moderate posterior Ischaemic Stroke (RICAMIS) investigation confirmed that this approach effectively enhances 90-day neurologic recovery among patients with acute moderate ischaemic stroke within 48 hours of symptom onset. A predefined subgroup suggested more benefit from this treatment in posterior circulation stroke (PCS). Aim To assess the efficacy and safety of RIC applied to patients presenting with acute moderate PCS. Sample size estimates Up to 960 eligible participants will be recruited for hypothesis testing of superiority, with statistical power set at 80% and a two-sided α level of 0.05. Stratified variables encompass sex, age, baseline systolic blood pressure, diabetic status, baseline National Institutes of Health Stroke Scale score, symptom-to-intervention interval, aetiological classification, infarct anatomical location and reperfusion intervention status. Methods and design RICAMIS2 is designed as a prospective, randomised, open-label, blinded-endpoint, multicentre clinical trial. Enrolled subjects will be allocated randomly to either the investigational arm or the control arm. Participants in the investigational arm receive standard stroke care combined with twice daily RIC administration at 200 mmHg pressure, sustained for 8–12 consecutive days. Participants in the control arm receive only standard stroke care. Study outcome The primary effectiveness endpoint is defined as favourable functional recovery, indicated by a modified Rankin Scale score ranging from 0 to 1, assessed at 90±7 days following random assignment. Conclusion This investigation is expected to furnish expanded evidence supporting the utility of RIC as a supplementary neuroprotective measure in the clinical management of acute ischaemic stroke. Trial registration number NCT06931535 .