A Study on the Application of Remote Ischemic Postconditioning Training in Patients after Mechanical Thrombectomy for Acute Ischemic Stroke

Abstract

Objective: This study examines the impact of remote ischemia post-conditioning (RIPostC) on clinical outcomes in patients who have undergone mechanical thrombectomy for acute ischemic stroke (AIS), with the aim of guiding improvements in patient outcomes. Methods: We selected 78 patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy in the Neurointensive Care Unit (NICU) of our hospital from January to December 2024 as study subjects. Patients were randomly assigned to either the experimental group or the control group using a random number table. All patients received identical standard general treatment, routine post-mechanical thrombectomy therapy, and nursing care. The experimental group additionally received remote ischemic postconditioning (RIPostC) treatment for 7 consecutive days, twice daily, with 5 cycles per session. An ischemic adaptation training device was used to alternately inflate and deflate both upper limbs for 5 minutes per session. The total training duration was 7 days. For the experimental group, the inflation pressure was set at 200 mmHg, and one complete RIPostC session was defined as five cycles (45 minutes). The control group received sham RIPostC treatment for 7 days. In the control group, the inflation pressure was set at 60 mmHg, which induced a sensation of limb constriction while maintaining palpable radial and brachial artery pulses. One complete sham session was also defined as five cycles (45 minutes). Both groups completed a total of 14 RIPostC/sham sessions. Evaluations were performed before the intervention, at 3 days and 7 days after the intervention, assessing NIHSS scores, modified Rankin Scale (mRS) scores, and laboratory markers (PCT, CRP, IL-6). Additional assessments of NIHSS and mRS scores were conducted before discharge and at the 90-day follow-up. Transcranial Doppler ultrasound (TCD) was used to evaluate blood flow velocity in the affected cerebral vessels, including peak systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), and pulsatility index (PI). Results: Of the 78 enrolled patients, 62 completed the study, including 32 in the experimental group and 30 in the control group. There were no statistically significant differences between the two groups in baseline characteristics such as gender, age, history of smoking and alcohol consumption, and past medical history (p > 0.05), indicating comparability. Seven days after intervention, the experimental group demonstrated significantly better outcomes than the control group in Vd, Vm, PI, mRS scores, NIHSS scores, PCT levels, and IL-6 levels (all p < 0.05). Similarly, at 3 days, 7 days, pre-discharge, and during the 90-day follow-up assessments, the experimental group showed consistently superior mRS and NIHSS scores compared to the control group (all p < 0.05). Repeated measures ANOVA indicated significant interaction effects between time and group for Vs, Vd, Vm, PI, mRS scores, NIHSS scores, CRP, and IL-6 (all p < 0.05). Notably, there were significant main effects of both time and group on mRS and NIHSS scores (p < 0.05), as well as significant main effects of time on Vs, Vd, Vm, PI, CRP, PCT, and IL-6 (p < 0.05). A total of 19 patients experienced adverse reactions in this study, including 15 in the experimental group and 4 in the control group. While the incidence of skin petechiae, dizziness, palpitations, and chest tightness showed no significant between-group differences (p > 0.05), the experimental group had a significantly higher incidence of skin ecchymosis and overall adverse event rate compared to the control group (both p < 0.05). All adverse reactions resolved after symptomatic treatment, and no serious adverse events occurred. Conclusion: RIPostC training can reduce the inflammatory response in patients with acute ischemic stroke (AIS) and improve cerebral blood flow perfusion in the affected area, and promote neurological recovery.