Mapping the current evidence on remote ischemic conditioning for acute ischemic stroke: a scoping review

Abstract

Remote ischemic conditioning (RIC) has shown promise in acute stroke care. This scoping review maps current evidence on the application, efficacy, safety, and implementation challenges of RIC, with a primary focus on acute ischemic stroke (AIS). Following PRISMA-ScR guidelines, we searched five databases (2015–2025) for clinical studies evaluating RIC in adult acute stroke patients. Twelve studies (seven RCTs, three pilot studies, one cohort, one case-control; total n = 5779) met inclusion criteria. Eleven studies focused exclusively on AIS, while only one included intracerebral hemorrhage (ICH), reflecting the limited evidence base for hemorrhagic stroke. RIC protocols varied substantially in timing (within 4 hours to 15 days post-stroke), frequency (single to 14-day regimens), and delivery method (manual vs. automated), with post-conditioning most commonly used. Neurological improvement (NIHSS) was reported in nine studies (mean difference: −1.0 to −1.5), but only three showed significant functional gains (modified Rankin Scale, odds ratios 1.21–1.8), highlighting outcome variability. No serious adverse events were reported; minor limb-related effects were infrequent. Greater efficacy was observed among non-reperfusion AIS patients. Despite theoretical feasibility, none of the studies were conducted in low-resource settings, and manual RIC protocols remain unvalidated in these environments. Long-term outcomes beyond 90 days were not assessed in any study. While RIC appears safe and potentially beneficial for neurological recovery in AIS, current evidence does not support its efficacy in ICH. Future research should prioritize standardized protocols, trials in hemorrhagic stroke, long-term follow-up, and validation in low-resource contexts to guide clinical adoption.