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Comment & Response
September 28, 2020

Remote Ischemic Perconditioning for the Treatment of Acute Ischemic Stroke—Reply

Author Affiliations
  • 1Unité Neurovasculaire et Service de Neurologie, Hôpital André Mignot–Centre Hospitalier de Versailles, Le Chesnay, France
  • 2Versailles Saint-Quentin-en-Yvelines University, Paris Saclay University, Versailles, France
  • 3Institut National de la Santé et de la Recherche Médicale Unité 1148, Laboratoire de Recherche Vasculaire Translationnelle–Paris, Paris, France
  • 4Neurology and Stroke Center, Hopital Foch, Suresnes, France
  • 5Assistance Publique–Hôpitaux de Paris Bichat Hospital, Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
JAMA Neurol. 2020;77(11):1452. doi:10.1001/jamaneurol.2020.3562

In Reply We thank Zhao et al for the interest in our randomized clinical trial.1 We agree that it is of interest to evaluate remote ischemic perconditioning specifically in patients with acute ischemic stroke and mismatch. We did not target these patients exclusively, because when the Remote Ischemic Conditioning in Acute Brain Infarction (RESCUE BRAIN) was designed in 2012, there was no proof of the efficacy of this approach; the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN)2 and Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE-3)3 trials were published in 2018. We also think that the results of the mismatch subgroup analysis should be taken with caution because of the neutral result on the primary outcome, the unplanned nature of this subgroup analysis, and the nonsignificant result. Regarding arterial status at 24 hours, we would like to clarify the fact that 88% of the patients had no arterial occlusion at 24 hours, distributed as follows: 38% of patients had no arterial occlusion at baseline, and 50% had a recanalized occlusion (compare with the eFigure in the Supplement).1 We therefore think that RESCUE BRAIN sufficiently addressed the question of interest of a single cycle of remote ischemic perconditioning treatment at hospital admission in patients with acute ischemic stroke and no persistent arterial occlusion at 24 hours.

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