Evaluating Antiplatelet and Physical Therapy for Slowing Progression in Mild Moyamoya Disease.

History of any form of intracranial hemorrhage, including subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage, etc.; history of symptomatic ischemic stroke; frequent transient ischemic attacks (TIAs) before enrollment, defined as ≥3 episodes within 7 days; or history of epileptic seizures.

Concomitant cerebrovascular diseases that may significantly affect perioperative risk or outcome assessment, such as intracranial aneurysms requiring concomitant treatment, cerebral arteriovenous malformations, arteriovenous fistulas, or other relevant cerebrovascular lesions.

History of severe traumatic brain injury, brain tumor, encephalitis, meningitis, or other inflammatory diseases of the central nervous system; other major intracranial diseases; any prior invasive intracranial treatment; or history of cranial radiotherapy.

Planned cerebral revascularization surgery within 3 months. Severe cardiac dysfunction (left ventricular ejection fraction <50% or New York Heart Association [NYHA] class III-IV), hepatic dysfunction (alanine aminotransferase [ALT] or aspartate aminotransferase [AST] >2 times the upper limit of normal), or renal dysfunction (serum creatinine >1.5 times the upper limit of normal); major systemic diseases such as unstable angina, acute coronary syndrome, asthma, or chronic obstructive pulmonary disease (COPD); severe noncardiovascular comorbidities with an expected survival of <1 year; or any other serious comorbidity considered by the investigator to significantly increase study-related risk.

Contraindications to aspirin, including:

1. Known allergy to aspirin;
2. Severe renal dysfunction (serum creatinine >1.5 times the upper limit of normal) or severe hepatic dysfunction (ALT or AST >2 times the upper limit of normal);
3. Severe heart failure (NYHA class III-IV);
4. Coagulation disorders or a history of systemic bleeding;
5. History of thrombocytopenia or neutropenia;
6. History of drug-induced hematologic disorders or hepatic injury;
7. White blood cell count <2×10⁹/L or platelet count <100×10⁹/L;
8. History of gastrointestinal bleeding within 3 months before enrollment, or a documented history of gastric ulcer or gastritis;
9. Any other contraindication to aspirin.

Contraindications to remote ischemic conditioning (RIC), including:

1. Peripheral vascular disease of the upper or lower extremities, particularly significant stenosis or occlusion of the brachial, ulnar, or radial arteries, or any condition considered by the investigator to make upper-arm cuff inflation for RIC unsuitable;
2. Conditions that may affect the safety of upper-limb RIC, including but not limited to severe skin or soft-tissue infection or injury, marked lymphedema, arteriovenous fistula or dialysis fistula, recent deep venous thrombosis, or inability to tolerate upper-arm cuff inflation as judged by the investigator, such as severe pain or recurrent subcutaneous bleeding;
3. Known allergy to the RIC device or any of its component materials. Requirement for aspirin and/or other antiplatelet therapy because of diseases other than moyamoya disease, such as systemic, circulatory, or hematologic disorders; or continuous use of other antiplatelet agents for ≥5 days before enrollment, with the last dose administered within 10 days before enrollment.

Requirement for anticoagulant therapy, including conditions such as atrial fibrillation, prosthetic heart valves, known or suspected endocarditis, venous thrombosis, or other diseases requiring anticoagulation; or use of heparin or oral anticoagulants within 10 days before enrollment.

Pregnancy, suspected pregnancy (defined as a positive pregnancy test in a woman of childbearing potential who has not used effective contraception), or breastfeeding.

Conditions that may interfere with completion of key follow-up assessments, such as severe cognitive impairment or psychiatric disorders resulting in inability to cooperate with study evaluations, or a clear expectation that follow-up cannot be completed.

Current participation in another interventional clinical trial that, in the investigator's judgment, may interfere with assessment of the study outcomes