Ischemic Conditioning during Air tRansport save penUmbral tissue - A Pilot Study (ICARUS)

Inclusion Criteria: 1. Age ≥18 and ≤ 80 years 2. Suspected acute ischemic stroke with symptoms suggestive of large vessel occlusion (aphasia, agnosia, neglect, visual field cut, and gaze preference). 3. Patient screened for rtPA, and rtPA administered if eligible 4. Subject or legally authorized representative able to provide consent at the time of the assessment 5. NIHSS 6-20

Exclusion Criteria: 1. Any intracranial hemorrhage (parenchymal, subarachnoid, subdural, epidural) on CT scan at the community hospital 2. History of upper or lower extremity ischemia, known subclavian, brachial artery, iliac or femoral artery stenosis, subclavian steal syndrome, any upper or lower extremity soft tissue, orthopedic or vascular injury, or mastectomy or other procedure that may contraindicate taking blood pressure or having a cuff on the arm or leg for the conditioning treatment 3. History of diabetes mellitus 4. Enrollment in another clinical trial 5. Patient incarcerated 6. Pregnancy. Patients ages 18-55 will need to have a negative urine or blood based pregnancy test. 7. Agitation deemed unsafe for ischemic preconditioning testing. 8. Arteriovenous fistula in upper limb