Neuroprotective Effect of Remote Ischemic Conditioning in Ischemic Stroke Treated With Mechanical Thrombectomy

NeuroPRotective Effect of remOte Ischemic condiTioning in Ischemic strokE Treated With meChanical Thrombectomy (PROTECT-I Study)

The benefit of mechanical thrombectomy in the treatment of ischemic stroke has been demonstrated in several multicenter randomized trials. However, it leads to a sudden reperfusion of the brain parenchyma associated to an extension of the infarct volume. Evidence has indicated that remote ischemic conditioning (RIC) reduces final infarct size in animal stroke models. The main objective of the present study is to determine whether remote ischemic conditioning can limit the final infarct volume after recanalization of the occluded cerebral artery.

Inclusion Criteria:

• Age at least 18 years old,
• Carotid ischemic stroke related to a full occlusion of the middle cerebral artery (occlusion of middle 1 (M1) and/or proximal middle 2 (M2) identified as candidate for endovascular intervention according to local criteria,
• Brain Magnetic Resonance Imaging (MRI) performed within 6 hours from symptoms onset,
• Acute stroke MRI including at least diffusion weighted imaging (DWI), fluid attenuated inversion recovery (FLAIR), intracranial vessel imaging with Magnetic Resonance Angiography (MRA) and perfusion weighted imaging (PWI),
• Modified Rankin Score (mRS) score less than or equal to 1 before ischemic stroke,
• Obtaining a written informed consent of the patient or a next of kin, or emergency inclusion process.

Non inclusion Criteria:

• Previous ischemic stroke or transient ischemic attack (TIA) in the previous 3 months,
• Contraindications to iodinated contrast agents,
• Sickle cell disease known (risk of vaso-occlusive crisis),
• Life expectancy less than 90 days,
• Pregnant or women of childbearing age who were not using contraception (oral diagnosis),
• Patient without health coverage,
• Patient under legal protection.
• Any contraindication to Magnetic Resonance Imaging (MRI) (example cardiac pacemaker),
• Intracranial bleeding,
• Intracranial expansive process.

Exclusion Criteria:

• Recanalization of M1 or proximal M2 segment at the time of thrombectomy