BACKGROUND: This study aimed to examine the effect of remote ischemic postconditioning on collateral circulation and TLR4/NF-kB signaling pathway in Chinese patients with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) stenosis. METHODS: A total of 96 patients with AIS due to MCA were randomly assigned to two groups (experimental group A and control group B). Patients in both groups underwent clinical treatment and physical training. The experiment group also received remote ischemic postconditioning training, where each patient was trained 5 days a week for 8 weeks. Computed tomography angiography (CTA) of intracranial and cervical arteries was used for evaluating leptomeningeal collaterals. Regional leptomeningeal collateral (rLMC) score was applied for all patients' collateral circulation evaluation. The National Institutes of Health Stroke Scale (NIHSS) score and the Fugl-Meyer Assessment (FMA) were applied for the evaluation of quality of life at baseline and endpoint. Blood samples were collected for analysis of plasma concentrations of TLR4 and NF-kB. RESULTS: Demographic data were similar between groups. At endpoint, compared with group B, the NIHSS score and serum levels of TLR4 and NF-kB in group A were significantly lower (p < 0.05), while the scores of FMA and rLMC in group A ware significantly higher (p < 0.05). Positive correlations were observed between levels of TLR4 and NF-kB (r = 0.689, p < 0.05). TLR4 levels were inversely correlated with rLMC score (r = -0.645, p < 0.05). CONCLUSIONS: The current results indicated that remote ischemic post conditioning therapy can down-regulate the overexpression of TLR4 and NF-kB after cerebral infarction, reduce inflammatory response, promote the formation of cerebral collateral circulation, improve motor function and improve quality of life in AIS patients, which might serve as a routine method for novel treatment of AIS.

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