Background <p>Postoperative stroke can undermine the benefits of endovascular stenting for cerebrovascular stenosis. This trial investigated whether adjunctive remote ischemic conditioning (RIC) improves cerebral blood flow (CBF) regulation and reduces the risk of postoperative stroke.</p> Methods <p>A total of 104 patients with intracranial or extracranial cerebrovascular stenosis who underwent endovascular stenting were enrolled and randomized to receive either RIC or sham-RIC (1:1). The intervention was administered twice daily for 7 consecutive days postoperatively. CBF regulation was assessed bilaterally using transfer function analysis of spontaneous blood pressure and CBF oscillations at baseline and on day 7 or at discharge. The primary outcomes were phase difference (PD) and gain, whereas the secondary outcomes were 90-day stroke incidence and safety.</p> Results <p>Significantly higher PD values were observed in the RIC group than in the sham-RIC group on the affected side (40.67° [26.76°–58.28°] vs. 20.51° [10.90°–41.73°], <i>P</i> &lt; 0.001) and the unaffected side (36.04° [21.66°–54.53°] vs. 26.80° [11.94°–44.83°], <i>P</i> = 0.022), indicating improved CBF regulation. Intragroup comparisons revealed significant PD improvement from baseline to day 7 or discharge in the RIC group (affected side: 20.57° [8.70°–34.24°] vs. 40.67° [26.76°–58.28°], <i>P</i> &lt; 0.001; unaffected side: 26.06° [8.70°–44.37°] vs. 36.04° [27.66°–54.53°], <i>P</i> = 0.001). The 90-day stroke incidence was significantly lower in the RIC group (0.00% vs. 9.62%, <i>P</i> = 0.022).</p> Conclusions <p>Adjunctive RIC safely enhanced CBF regulation and substantially reduced postoperative stroke in patients after cerebrovascular stenting, suggesting a promising non-pharmacological strategy to improve outcomes.</p> Trial registration <p>This trial was registered at ClinicalTrials.gov (NCT05970653).</p>