Effect of remote ischemic postcondition combined with intravenous thrombolysis on acute cerebral infarction and cytokines

Objective To investigate the effect of remote ischemic postcondition (RIPostC) combined with intravenous thrombolysis on the outcome of patients with acute cerebral infarction and its impact on vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP9).Methods A total of 169 acute cerebral infarction patients who were admitted to Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2022 were enrolled. They were randomly divided into two groups:a control group (n=85) and an intervention group (n=84). All the patients received intravenous thrombolytic therapy with recombinant plasminogen activator (rt-PA) and sequential standard drug treatment, while the intervention group received RIPostC. Their demographics and baseline clinical data were collected. The 90-day modified Rankin scale (mRS) scores were evaluated, and the levels of VEGF and MMP9 at admission, at post-admission 24 h, and at post-admission 7 days were measured. Poor outcome was defined as a mRS score of ≥ 2 at 90 days. Multivariate logistic regression analysis was used to evaluate the independent correlation between RIPostC treatment and poor prognosis.Results The intervention group showed that 68.2% of patients scored 0-1 on the 90-day mRS score, compared with 51.2% in the control group, with statistical difference (P=0.024). Multivariate logistic regression analysis showed that, RIPostC intervention (OR 0.372, 95% CI 0.172-0.805, P=0.012), and baseline NIHSS score (OR 1.336, 95%CI 1.184-1.508, P<0.001) were independently associated with 90-day prognosis. There was statistical difference in VEGF and MMP9 levels within the same group at admission, at post-admission 24 h, and at post-admission 7 days (P<0.001). There was no statistical difference in VEGF and MMP9 levels between the two groups at the above three measurement time points (P>0.05).Conclusions RIPostC combined with intravenous thrombolysis can promote the recovery of neurological function and improve the prognosis in patients with acute cerebral infarction.