Fig. 1

Schematic diagram of the potential and expected neuroprotective effects of remote ischemic perconditioning (RIPerC) on ischemic stroke at the acute phase. RIPerC refers to the application of several cycles of press and release by an automatic device in a prehospital setting (ambulance) to an upper non-affected limb. Its clinical application is safe, feasible and well tolerated. The underlying RIPerC mechanisms include mitochondrial protection, activation of inflammasome, neurovascular protection and specific anti-inflammatory pathway regulation. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and reveal underlying neuroprotective mechanisms. Abbreviations: CBF, cerebral blood flow; TNF-a, tumor necrosis factor alpha; IL-6, interleukin 6; IL-10, interleukin 10; SDF-1a, stromal cell-derived factor-1; HIF-1a, hypoxia-inducible factor 1-alpha; mTOR, mammalian target of rapamycin; MMPs, matrix metallopeptidases; ROS, reactive oxygen species