Effect of Remote Ischemic Preconditioning on Early Neurological Deterioration in Acute Perforating Artery Infarction

Inclusion Criteria: 1. Age 18 years or older; 2. Diagnosed with acute ischemic stroke; 3. Clinical symptoms consistent with perforating artery infarction (NIHSS score ≤5, with consciousness item 1a ≤1); 4. Time from onset to randomization within 48 hours; 5. Diffusion-weighted imaging (DWI) showing a single infarct in the perforating artery territory with a maximum diameter ≤30 mm, meeting at least one of the following: (1) Diameter ≤15 mm and involving two or more axial slices; (2) Maximum diameter ≥15 mm; (3) Connected to the ventral surface of the pons but not crossing the midline; 6) Stenosis of parent artery \<70%; 7) Signed informed consent obtained from the patient or their legally authorized representative. Exclusion Criteria: 1. Received intravenous thrombolysis or endovascular treatment prior to randomization; 2. Secondary stroke caused by brain tumor, traumatic brain injury, hematologic disorders, or other conditions; 3. History of intracranial hemorrhage; 4. Presence of RIC contraindications, such as severe upper limb soft tissue injury, fracture, subclavian artery stenosis, or peripheral vascular disease; 5. Uncontrolled severe hypertension (systolic blood pressure \[BP\] ≥180 mmHg or diastolic BP ≥110 mmHg); 6. Severe hepatic or renal dysfunction (Alanine Aminotransferase or Aspartate Aminotransferase \> 3 × upper limit of normal; creatine kinase \>3 × upper limit of normal; estimated Glomerular Filtration Rate \< 30 mL / min / 1.73 m²); 7. Patients with thrombocytopenic purpura, coagulation disorders, or active visceral bleeding; 8. Patients in the acute phase of fundus hemorrhage; 9. History of severe aphasia or psychiatric disorders affecting clinical assessment; 10. Life expectancy \<90 days; 11. Pregnancy; 12. Inability to comply with follow-up; 13. Participation in other clinical trials.