Prevention of Ischemic Conditions in Non-disabling Stroke/Transient Ischemic Attack With Remote Ischemic Conditioning

Study Overview
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Brief Summary
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This is a single-arm, open-labeled and phase II futility study. Application of Remote ischemic conditioning (RIC) as an adjunctive therapy to medication were involved in the study. The study is to test whether RIC is effective in preventing ischemic evens after a minor ischemic stroke/transient ischemic attack within 3 months and to explore the safety and compliance of chronic RIC. Medication strategy is based on physician's best judgement.

Detailed Description
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This is a single-arm, open-labeled and phase II futility study. Application of Remote ischemic conditioning (RIC) as an adjunctive therapy to medication were involved in the study. RIC consisted of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on bilateral upper limbs twice a day. The study is to test whether RIC is effective in preventing ischemic evens after a minor ischemic stroke/transient ischemic attack within 3 months and to explore the safety and compliance of chronic RIC. Medication strategy is based on physician's best judgement.

Official Title
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Feasibility of Applying Remote Ischemic Conditioning in Secondary Prevention in Patients With Minor Ischemic Stroke or Transient Ischemic Attack -A Single-arm Futility Study

Conditions
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Transient Ischemic Attack, Non-disabling Stroke

Intervention / Treatment
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* Device: Remote Ischemic Conditioning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eighteen years old or older of any gender or race; Diagnosed with a non-cardiogenic MIS/TIA within 14 days; MIS is defined by an ischemic stroke of score of 3 or less on the NIHSS at the time of inclusion, TIA is defined as neurologic deficit attributed to focal brain ischemia, with symptoms resolution within 24 h of symptom onset, Symptom onset is defined by the last see normal principle; Stable vital signs, normal cardiac, hepatic and renal functions; Able to consent by himself/herself or by legally authorized representative. Exclusion Criteria: Diagnosis of hemorrhage or other pathology, such as vascular malformation, tumor, abscess or other non-vascular diseases, based on brain CT or MRI; Modified Rankin Scale score > 2 at inclusion; Received iv. recombinant tissue plasminogen activator (rtPA) therapy or interventional treatment for the current event; Contradiction for aspirin or clopidogrel (known allergy, severe asthma or heart failure et al.) ; Clear indication for anticoagulation therapy ( cardiac source of embolus); Hemorrhagic tendency of any reason （including but not limit to Hemostatic disorder, platelet count <100 × 109/L, history of drug-induced hepatic dysfunction）; Any hemorrhagic transformation; Gastrointestinal bleed or major surgery within 3 months of symptoms onset; Stroke or TIA induced by interventional therapy or surgery; Any upper extremity soft tissue, vascular injury or peripheral blood vessel disease which may contraindicate RIC; Systolic blood pressure greater than 200 mmHg after medication; Planned revascularization (any angioplasty or vascular surgery) within the next 3 months ； Scheduled for surgery or interventional treatment requiring RIC cessation within next 3 months; Severe noncardiovascular comorbidity with life expectancy < 3 months; Pregnancy; Currently receiving an investigational drug or device by other studies.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Interventional Model Description: Patients will receive remote ischemic conditioning
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Remote Ischemic Conditioning<br>RIC (remote ischemic conditioning) consists of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on bilateral upper limbs twice a day. Medication strategy is based on physician's best judgement. | Device: Remote Ischemic Conditioning<br>* RIC consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on bilateral upper limbs twice a day. Medication strategy is based on physician's best judgement.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recurrent rate of ischemic stroke/transient ischemic stroke |  | within 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment-Related Adverse Events | pain and tolerability, redness, bleeding, palpitation | within 3 months | 
| Compliance of remote ischemic conditioning | the proportion of patients fulfill the treatment | within 3 months | 
| Incidence rate of vascular events | hemorrhage stroke, myocardial infarction and vascular death | within 3 months | 
| Improvements in NIH Stroke Scale | improvements in NIH Stroke Scale in patients without recurrence or vascular events | within1, 3 months | 
| Improvements in modified Rankin Scale | improvements in modified Rankin Scale Scale in patients without recurrence or vascular events | within 1, 3 months | 
| Improvements in Barthel Scale | improvements in Barthel Scale in patients without recurrence or vascular events | within 1,3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Minor Ischemic Stroke, Transient Ischemic Attack, Remote Ischemic Conditioning