Remote Ischemic Conditioning for Acute Ischemic Stroke Treated With Mechanical Thrombectomy（RECAST-MT） (RECAST-MT)

Safety and Efficacy of Remote Ischemic Conditioning for Acute Ischemic Stroke Treated With Mechanical Thrombectomy (RECAST-MT): A Multicenter, Randomized, Controlled, Open-label, Blinded Endpoint Trial

For patients with acute ischemic stroke caused by large vessel occlusion, endovascular thrombectomy has been demonstrated to be the most effective therapy, as approximately 90% of the occluded vessels can be recanalized. However, less than 50% of patients could achieve functional independence, and over 15% died 90 days after stroke. Although the mismatch of successful recanalization with poor prognosis can be attributed to many factors, the infarct core formed during thrombectomy and reperfusion injury after thrombectomy may be among the most important and effective neuroprotective strategies urgently needed.

Remote ischemic conditioning (RIC) is a noninvasive strategy in which one or more cycles of brief and transient limb ischemia confer protection against prolonged and severe ischemia in distant organs. In the transient focal cerebral ischemia-reperfusion model, the application of remote ischemic conditioning before reperfusion or both before and after reperfusion reduces reperfusion injuries and the final infarct size. Because patients with acute ischemic stroke who are treated with endovascular thrombectomy can achieve a high rate of recanalization after focal ischemia, this patient population is akin to the model of transient focal cerebral ischemia-reperfusion. Furthermore, a pilot study has determined the safety and feasibility of remote ischemic conditioning in patients undergoing endovascular thrombectomy. However, whether remote ischemic conditioning could provide clinical benefits to patients with acute ischemic stroke who are treated with endovascular thrombectomy urgently needs investigations.

This study aims to investigate the safety and efficacy of remote ischemic conditioning in improving functional outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy and explore the effect of treatment duration on the treatment outcome of remote ischemic conditioning.

Study Overview

• Status: Recruiting
• Conditions: Acute Ischemic Stroke; Anterior Circulation Brain Infarction
• Intervention / Treatment: Procedure: Endovascular thrombectomy; Drug: Best medical management; Device: 14-day remote ischemic conditioning; Device: 30-day remote ischemic conditioning

• Study Type: Interventional
• Enrollment (Estimated): 2105
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Xunming Ji, MD, PhD; Phone Number: 010-8319-9439; Email: jixm@ccmu.edu.cn
• Study Contact Backup: Name: Sijie Li, MD; Phone Number: +8613581610258; Email: lisijie@xwh.ccmu.edu.cn

Study Locations

• China
  • Beijing, China, 100053
    • Recruiting
    • Xuanwu Hospital, Capital Medical University
    • Contact: Xunming Ji, MD, PhD; Phone Number: 010-83199430; Email: jixm@ccmu.edu.cn
    • Contact: Sijie Li, MD; Phone Number: 86-13581610258; Email: lisijie@xwh.ccmu.edu.cn
  • Beijing, China, 100020
    • Recruiting
    • Beijing Chao-Yang Hospital
    • Contact: Yang Wang
  • Beijing, China, 100049
    • Recruiting
    • Aerospace central hospital
    • Contact: Peifu Wang
  • Beijing, China, 100071
    • Recruiting
    • Beijing Fengtai You'anmen Hospital
    • Contact: Jing Wang
  • Beijing, China, 100085
    • Recruiting
    • Beijing Red Cross Emergency Medical Center
    • Contact: Guohui Zhao
  • Beijing, China, 102600
    • Recruiting
    • Beijing Daxing District People'S Hospital
    • Contact: Jinglin Yuan
  • Chongqing, China, 408000
    • Not yet recruiting
    • Chongqing University Fuling Hospital
    • Contact: Tao Wang
  • Anhui
    • Suzhou, Anhui, China, 234000
      • Recruiting
      • Suzhou Municipal Hospital of Anhui Province
      • Contact: Lei Zhang
    • Taihe Chengguanzhen, Anhui, China, 236600
      • Recruiting
      • Taihe County People's Hospital
      • Contact: Tao Cui
    • Tongling, Anhui, China
      • Recruiting
      • Tongling People's Hospital
      • Contact: Tao Wang
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100000
      • Recruiting
      • Beijing Luhe Hospital Affiliated to Capital Medical University
      • Contact: Xiaokun Geng
    • Beijing, Beijing Municipality, China, 100010
      • Recruiting
      • Beijing Fangshan District First Hospital
      • Contact: Liang Chen
  • Fujian
    • Fuzhou, Fujian, China, 350028
      • Not yet recruiting
      • Fujian Provincial Hospital
      • Contact: Qiong Cheng
    • Zhangzhou, Fujian, China, 363000
      • Recruiting
      • Zhangzhou Municipal Hospital of Fujian Province
      • Contact: Tingyu Yi
  • Guangdong
    • Shenzhen, Guangdong, China, 518000
      • Not yet recruiting
      • Shenzhen Second People's Hospital
      • Contact: Pengcheng Fu
    • Shenzhen, Guangdong, China, 518000
      • Recruiting
      • South China Hospital Affiliated to Shenzhen University
      • Contact: Shiwei Du
  • Guangxi
    • Nanning, Guangxi, China, 530000
      • Recruiting
      • The Second Nanning People's Hospital
      • Contact: Tong Li
  • Hebei
    • Cangzhou, Hebei, China, 061000
      • Recruiting
      • Cangzhou Central Hospital
      • Contact: Yongchang Liu
    • Shijiazhuang, Hebei, China, 050047
      • Recruiting
      • Army Medical University Noncommissioned Officer School Affiliated Hospital
      • Contact: Jin Li
    • Shijiazhuang, Hebei, China, 455001
      • Not yet recruiting
      • Hebei General Hospital
      • Contact: Guodong Xu
  • Heilongjiang
    • Jiamusi, Heilongjiang, China, 154000
      • Recruiting
      • The Hongda Hospital of Jiamusi University
      • Contact: Changsi Ai
  • Henan
    • Hebi, Henan, China, 456250
      • Recruiting
      • Xunxian People's Hospital
      • Contact: Beihai Jiang
    • Jiaozuo, Henan, China, 454000
      • Recruiting
      • Jiaozuo Coal Industry Group Co., Ltd. Central Hospital
      • Contact: Qianqian Qiu
    • Luoyang, Henan, China, 471000
      • Recruiting
      • Luoyang Yanshi People's Hospital
      • Contact: Yang Zhou
    • Nanyang, Henan, China, 473000
      • Recruiting
      • Nanyang Central Hospital
      • Contact: Changming Wen
    • Zhengzhou, Henan, China, 450000
      • Not yet recruiting
      • Henan Province People's Hospital
      • Contact: Liangfu Zhu
    • Zhoukou, Henan, China, 466600
      • Recruiting
      • Xihua County People's Hospital
      • Contact: Chaoqun Li
  • Hubei
    • Huanggang, Hubei, China, 438000
      • Recruiting
      • Huanggang Central Hospital
      • Contact: Jiajun Wang
    • Huangshi, Hubei, China, 435000
      • Recruiting
      • Huangshi Central Hospital
      • Contact: Chensong Deng
    • Jingmen, Hubei, China, 448000
      • Recruiting
      • Jingmen Central Hospital
      • Contact: Ying Wei
    • Jingmen, Hubei, China, 448000
      • Recruiting
      • Jingmen People's Hospital
      • Contact: Wei Li
    • Tianmen, Hubei, China, 430000
      • Suspended
      • First People's Hospital of Tianmen
    • Wuhan, Hubei, China, 430000
      • Recruiting
      • Zhongnan Hospital of Wuhan University
      • Contact: Huagang Li; Phone Number: 8617762473010
    • Wuhan, Hubei, China, 430033
      • Not yet recruiting
      • The Third People's Hospital of Hubei Province
      • Contact: Yue Wan
    • Yichang, Hubei, China, 443000
      • Recruiting
      • Yichang Central People's Hospital
      • Contact: Huajun Zhou
  • Hunan
    • Changde, Hunan, China, 415000
      • Recruiting
      • The First People's Hospital of Changde
      • Contact: Jun Wen
    • Changsha, Hunan, China, 410000
      • Recruiting
      • The third xiangya hospital of Central South University
      • Contact: Yi Yuan
    • Chenzhou, Hunan, China, 423000
      • Not yet recruiting
      • The First People's Hospital of Chenzhou
      • Contact: Xiaoxi Yao
    • Xiangtan, Hunan, China, 411100
      • Not yet recruiting
      • The Central Hospital of Xiangtan
      • Contact: Guangxiong Yuan
  • Inner Mongolia
    • Hohhot, Inner Mongolia, China, 010000
      • Not yet recruiting
      • Inner Mongolia Autonomous Region People's Hospital
      • Contact: Dong Wang
  • Jiangsu
    • Suzhou, Jiangsu, China, 215006
      • Recruiting
      • The First Affiliated Hospital of Soochow University
      • Contact: Qi Fang
    • Suzhou, Jiangsu, China, 215000
      • Recruiting
      • The Fourth Affiliated Hospital of Soochow University
      • Contact: Qi Fang
  • Liaoning
    • Anshan, Liaoning, China, Anshan
      • Recruiting
      • Anshan Changda Hospital
      • Contact: Fan Zhang
    • Dalian, Liaoning, China, 116000
      • Recruiting
      • The First Affiliated Hospital of Dalian Medical University
      • Contact: Ke Li
    • Dalian, Liaoning, China, 116000
      • Not yet recruiting
      • Dalian Central Hospital
  • Shandong
    • Dongying, Shandong, China, 257000
      • Recruiting
      • Shengli Oilfield Central Hospital
      • Contact: Ye Lang
    • Jinan, Shandong, China, 250000
      • Recruiting
      • Jinan Third People's Hospital
      • Contact: Yan Li
    • Liaocheng, Shandong, China, 252000
      • Recruiting
      • Liaocheng People's Hospital
      • Contact: Liyong Zhang
    • Liaocheng, Shandong, China, 252000
      • Recruiting
      • Liaocheng Third People's Hospital
      • Contact: Lei Yang
    • Liaocheng, Shandong, China, 252800
      • Recruiting
      • The People's Hospital of Gaotang
      • Contact: Huqing Li
    • Linyi, Shandong, China, 273400
      • Suspended
      • Feixian People's Hospital
    • Yantai, Shandong, China
      • Recruiting
      • YEDA hospital
      • Contact: Wenjun Qian
  • Sichuan
    • Mianyang, Sichuan, China, 621000
      • Recruiting
      • Mianyang Third People's Hospital
      • Contact: Hongxia Yang
    • Ya'an, Sichuan, China, 625000
      • Recruiting
      • Ya 'an People's Hospital
      • Contact: Jian Wang
  • Zhejiang
    • Wenzhou, Zhejiang, China, 325000
      • Recruiting
      • The Second Affiliated Hospital of Wenzhou Medical University
      • Contact: Bo Yin
    • Yueqing, Zhejiang, China, 325600
      • Recruiting
      • Yueqing People's Hospital
      • Contact: Saizhen Wu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age≥18 years；
2. Acute ischemic stroke due to large vessel occlusion in the anterior circulation that is not suitable for intravenous thrombolytic therapy, or has contraindications to intravenous thrombolytic therapy, or treated with intravenous thrombolytic therapy without recanalization;
3. Large vessel occlusion confirmed by computed tomography angiography (CTA) or magnetic resonance angiography (MRA), including the occlusion of the intracranial segment of the internal carotid artery (ICA) and M1 segment of the middle cerebral artery (MCA), is the cause of symptoms, and mechanical thrombectomy is planned within 24 hours from the time last known well;
4. Baseline score of the National Institutes of Health Stroke Scale (NIHSS) ≥ 6 points;
5. Patients or family members signed a written informed consent form.

Exclusion Criteria:

1. Imaging examination revealed the presence of multiple vascular supply areas of cerebral infarction (such as the simultaneous presence of infarction in both anterior and posterior circulation);
2. Absence of femoral artery pulsation, extremely difficult intravascular access, or extremely tortuous large vessels, which are expected to result in the inability to undergo timely endovascular treatment;
3. Difficult-to-control hypertension: continuous monitoring upon admission shows systolic blood pressure ≥180mmHg, or diastolic blood pressure ≥100mmHg;
4. Coma or lethargy patients (consciousness level score ≥2 in NIHSS);
5. Unable to obtain an accurate baseline NIHSS score;
6. Pre-stroke modified Rankin Scale (mRS) score >1;
7. Baseline ASPECTS score ≤5;
8. Presence of bleeding tendency, deficiency of coagulation factors, or oral anticoagulant therapy with INR > 3.0;
9. Baseline blood glucose <2.7mmol/L or >22.2mmol/L;
10. Baseline platelet count < 30*10^9/L;
11. Severe known renal impairment defined as requiring dialysis (hemodialysis or peritoneal dialysis), or if known creatinine clearance rate <30mL/min;
12. Cranial CT or MRI shows intracranial hemorrhage;
13. Cranial CT or MRI shows midline deviation and significant occupying effect;
14. Clinical history, previous imaging examinations, or clinical judgment suggesting intracranial tumors, arteriovenous malformations, or intracranial arterial dissection;
15. History of head injury in the past 3 months;
16. History of life-threatening allergy to contrast agents, nickel, titanium metal, or their alloys;
17. Pregnancy, if women of childbearing age have a positive urinary or serum β-human chorionic gonadotropin (β-hCG) test or are breastfeeding；
18. The life expectancy of patients is less than 6 months, and they cannot be evaluated within 3 months;
19. Limb deformity, soft tissue injury, or other conditions that affect the implementation of distant ischemia adaptation therapy;
20. Participating in other ongoing clinical trials;
21. Other conditions that the investigators believe are not suitable for participation in this study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control group; Patients in the control group will receive endovascular thrombectomy and the best medical management according to the guidelines.	Procedure: Endovascular thrombectomy; Endovascular thrombectomy procedures are performed according to the guidelines to recanalize the occluded large vessel safely.; Other Names: EVT; Drug: Best medical management; Best medical management is prescribed at the discretion of the treating physicians according to the guidelines.
Experimental: 14-day treatment group; Patients in the 14-day treatment group will receive endovascular thrombectomy and the best medical management according to the guidelines. In addition, this group will receive remote ischemic conditioning once pre-thrombectomy and twice daily for 14 days post-thrombectomy.	Procedure: Endovascular thrombectomy; Endovascular thrombectomy procedures are performed according to the guidelines to recanalize the occluded large vessel safely.; Other Names: EVT; Drug: Best medical management; Best medical management is prescribed at the discretion of the treating physicians according to the guidelines.; Device: 14-day remote ischemic conditioning; RIC is a noninvasive therapy performed by an electric auto-control device with a cuff placed on the upper arm. RIC procedures consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of the cuff on the upper arm. The procedure will be performed once before endovascular thrombectomy and twice daily for 14 days post-thrombectomy.; Other Names: 14-day RIC
Experimental: 30-day treatment group; Patients in the 30-day treatment group will receive endovascular thrombectomy and the best medical management according to the guidelines. In addition, this group will receive remote ischemic conditioning once pre-thrombectomy and twice daily for 30 days post-thrombectomy.	Procedure: Endovascular thrombectomy; Endovascular thrombectomy procedures are performed according to the guidelines to recanalize the occluded large vessel safely.; Other Names: EVT; Drug: Best medical management; Best medical management is prescribed at the discretion of the treating physicians according to the guidelines.; Device: 30-day remote ischemic conditioning; RIC is a noninvasive therapy performed by an electric auto-control device with a cuff placed on the upper arm. RIC procedures consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of the cuff on the upper arm. The procedure will be performed once before endovascular thrombectomy and twice daily for 30 days post-thrombectomy.; Other Names: 30-day RIC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of patients achieving a modified Rankin Scale (mRS) score of 0-2 at 90 days.	The mRS ranges from 0 to 6, with higher scores indicating worse outcomes.	90 days after stroke.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Two dichotomous mRS scores at 90 days (0-1 vs 2-6, 0-3 vs 4-6, 0-4 vs 5-6, 0-5 vs 6).	The mRS ranges from 0 to 6, with higher scores indicating worse outcomes.	90 days after stroke.
The ordinal distribution of mRS scores at 90 days.	The mRS ranges from 0 to 6, with higher scores indicating worse outcomes.	90 days after stroke.
The proportion of patients with early neurological improvement 24 hours after endovascular procedures.	The NIHSS ranges from 0 to 42, with higher scores indicating worse outcomes. Neurological improvement is defined as the NIHSS recovering to ≤2 points or decreasing by 8 points or much higher as compared with the baseline.	24 hours after endovascular procedures.
Changes in NIHSS score from baseline to day 14 or at discharge (whichever comes earlier).	The NIHSS ranges from 0 to 42, with higher scores indicating worse outcomes.	14 days or at discharge (whichever comes first)
Score of EQ-5D-5L at 90 days.	EQ-5D-5L is a tool used to assess health status, including five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. A higher score indicates a better health status, while a lower score indicates a poorer health status.	90 days after stroke.
Cerebral infarct volume.	The infarction volume will be assessed on cranial CT or MRI imaging.	72 hours after endovascular procedures.
The change of infarct volume.	Infarct Expansion Ratio (IER, IER=infarct volume/baseline infarct volume). The infarction volume will be assessed on cranial CT or MRI imaging, and baseline infarct volume will be assessed on the CTP or baseline MRI imaging.	72 hours after endovascular procedures.
Incidence of intracranial hemorrhage.	Intracranial hemorrhage is defined as the demonstration of hemorrhage within brain parenchyma on head imaging, according to the criteria of the ECASS III.	Within 14 days after endovascular procedures.
Incidence of Symptomatic Intracranial Hemorrhage	Symptomatic intracranial hemorrhage is defined as the demonstration of hemorrhage within brain parenchyma on head imaging leading to an increase of at least 4 points in the NIHSS score, according to the criteria of the European Cooperative Acute Stroke Study III (ECASS III).	Within 14 days after endovascular procedures.
Incidence of neurological deterioration within 14 days.	Neurological deterioration is defined as an increase of ≥4 points in NIHSS compared to before deterioration within 14 days.	Within 14 days after endovascular procedures.
Incidence of malignant infarction	Malignant infarction is defined as infarction involving more than half of the affected middle cerebral artery area, a significant mass effect requiring decompressive craniectomy, and/or directly leading to death with clinical signs of brain herniation.	0-90 days
All cause of death.	The incidence of death events at any time from randomization through day 90.	0-90 days
Incidence of Adverse Events/Serious Adverse Events	The incidence of other adverse events and serious adverse events at any time from randomization through day 90.	0-90 days

Collaborators and Investigators

• Sponsor: Capital Medical University

Publications and helpful links

General Publications

• Zhao W, Meng R, Ma C, Hou B, Jiao L, Zhu F, Wu W, Shi J, Duan Y, Zhang R, Zhang J, Sun Y, Zhang H, Ling F, Wang Y, Feng W, Ding Y, Ovbiagele B, Ji X. Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting: A Proof-of-Concept, Randomized Controlled Trial. Circulation. 2017 Apr 4;135(14):1325-1335. doi: 10.1161/CIRCULATIONAHA.116.024807. Epub 2017 Feb 7.
• Zhao W, Wu C, Dornbos D 3rd, Li S, Song H, Wang Y, Ding Y, Ji X. Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes. Brain Circ. 2020 Feb 18;6(1):11-18. doi: 10.4103/bc.bc_58_19. eCollection 2020 Jan-Mar.
• An JQ, Cheng YW, Guo YC, Wei M, Gong MJ, Tang YL, Yuan XY, Song WF, Mu CY, Zhang AF, Saguner AM, Li GL, Luo GG. Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke. Neurology. 2020 Dec 15;95(24):e3355-e3363. doi: 10.1212/WNL.0000000000010884. Epub 2020 Oct 7.
• Wang Y, Huang S, Liu L, Ji X, Zhao W, Li S; RECAST-MT investigators. Safety and Efficacy of Remote Ischaemic Conditioning for Acute Ischaemic Stroke Treated with Mechanical Thrombectomy (RECAST-MT): rationale and design. Stroke Vasc Neurol. 2025 Nov 25:svn-2025-004591. doi: 10.1136/svn-2025-004591. Online ahead of print.

Study record dates

Study Major Dates

• Study Start (Actual): September 23, 2024
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): February 1, 2027

Study Registration Dates

• First Submitted: August 4, 2024
• First Submitted That Met QC Criteria: August 16, 2024
• First Posted (Actual): August 19, 2024

Study Record Updates

• Last Update Posted (Actual): December 10, 2025
• Last Update Submitted That Met QC Criteria: December 3, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Remote ischemic conditioning; Endovascular thrombectomy; Cerebroprotection
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Brain Ischemia; Infarction; Necrosis; Ischemia; Stroke; Pathological Conditions, Signs and Symptoms; Ischemic Stroke; Brain Infarction
• Other Study ID Numbers: RECAST-MT

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No