Effect of Remote Ischemic Preconditioning on Early Neurological Deterioration in Acute Perforating Artery Infarction

Prior treatment

• Received intravenous thrombolysis or endovascular treatment prior to randomization;

Other illness

• Secondary stroke caused by brain tumor, traumatic brain injury, hematologic disorders, or other conditions;
• History of intracranial hemorrhage;
• Presence of RIC contraindications, such as severe upper limb soft tissue injury, fracture, subclavian artery stenosis, or peripheral vascular disease;
• Uncontrolled severe hypertension (systolic blood pressure \[BP\] ≥180 mmHg or diastolic BP ≥110 mmHg);
• Patients with thrombocytopenic purpura, coagulation disorders, or active visceral bleeding;
• Patients in the acute phase of fundus hemorrhage;
• History of severe aphasia or psychiatric disorders affecting clinical assessment;

Other

• Severe hepatic or renal dysfunction (Alanine Aminotransferase or Aspartate Aminotransferase \> 3 × upper limit of normal; creatine kinase \>3 × upper limit of normal; estimated Glomerular Filtration Rate \< 30 mL / min / 1.73 m²);
• Life expectancy \<90 days;
• Pregnancy;
• Inability to comply with follow-up;
• Participation in other clinical trials.

• Age 18 years or older;
• Diagnosed with acute ischemic stroke;
• Clinical symptoms consistent with perforating artery infarction (NIHSS score ≤5, with consciousness item 1a ≤1);
• Time from onset to randomization within 48 hours;
• Diffusion-weighted imaging (DWI) showing a single infarct in the perforating artery territory with a maximum diameter ≤30 mm, meeting at least one of the following:
  • (1) Diameter ≤15 mm and involving two or more axial slices; (2) Maximum diameter ≥15 mm; (3) Connected to the ventral surface of the pons but not crossing the midline; 6) Stenosis of parent artery \<70%; 7) Signed informed consent obtained from the patient or their legally authorized representative.