{"id":24773,"date":"2023-11-08T04:47:00","date_gmt":"2023-11-07T20:47:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24773"},"modified":"2023-11-08T05:35:04","modified_gmt":"2023-11-07T21:35:04","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%80%a5%e6%80%a7%e5%8d%92%e4%b8%ad%e6%82%a3%e8%80%85%e7%9a%84%e8%bf%9c%e5%a4%84%e7%bc%ba%e8%a1%80%e9%a2%84%e5%a4%84%e7%90%86","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24773","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6025\u6027\u5352\u4e2d\u60a3\u8005\u7684\u8fdc\u5904\u7f3a\u8840\u9884\u5904\u7406"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

October 3, 2023<\/p>\n\n\n\n

Remote Ischemic Conditioning for Acute Stroke: The RESIST Randomized Clinical Trial<\/h1>\n\n\n\n

Rolf Ankerlund\u00a0Blauenfeldt,\u00a0Niels\u00a0Hjort,\u00a0Jan Brink\u00a0Valentin,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;330(13):1236-1246. doi:10.1001\/jama.2023.16893<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does combined prehospital and in-hospital remote ischemic conditioning (RIC) improve functional outcome in patients with acute ischemic stroke or intracerebral hemorrhage?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 1500 patients with a suspected stroke in the prehospital setting, RIC treatment, compared with a sham control, did not significantly improve functional outcomes at 90 days in patients with a confirmed diagnosis of stroke (odds ratio for a favorable shift on the mRS score, 0.95).<\/p>\n\n\n\n

Meaning<\/strong>  Among patients with acute stroke, RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023).<\/p>\n\n\n\n

Intervention<\/strong>  The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, \u2264200 mm Hg [n\u2009=\u2009749] and sham cuff pressure, 20 mm Hg [n\u2009=\u2009751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20,\u00a0P<\/em>\u2009=\u2009.67; absolute difference in median mRS score, \u22121; \u22121.7 to \u22120.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11;\u00a0P<\/em>\u2009=\u2009.68). Upper extremity pain during treatment and\/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT03481777<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  October 3, 2023 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24773"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24773"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24773\/revisions"}],"predecessor-version":[{"id":24774,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24773\/revisions\/24774"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24773"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24773"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24773"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}