The effect of head position as a nonpharmacological therapy on acute ischemic stroke (AIS) remains inconclusive. Recent HOPES2 (Head dOwn-Position for acutE moderate ischemic Stroke with large artery atherosclerosis) suggest the safety, feasibility, and potential benefit of the head-down position (HDP) in acute ischemic stroke. The current study aims to investigate the efficacy and safety of HDP in acute moderate ischemic stroke patients with large artery atherosclerosis.
Age ≥ 18 years old
Acute ischemic stroke confirmed by NCCT or MRI;
Moderate neurologic deficit (6≤ NIHSS ≤ 16) within 24 hours of onset, or progressing from mild (NIHSS ≤ 5) to moderate neurologic deficit (6≤ NIHSS ≤ 16) within 24 hours, requiring ≥ 4 point increase in NIHSS score although the onset time is beyond 24 hours;
Probable large artery atherosclerosis etiology based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria (responsible artery stenosis ≥ 50% or occlusion);
Pre-stroke disability (mRS≥3);
Patients with disturbance of consciousness;
Patients who plan to undergo or have completed thrombolysis or mechanical thrombectomy;
Hemorrhagic stroke or combined ischemic and hemorrhagic stroke;
Parallel
head-down position
Other intervention-20° Trendelenburg as an adjunct to guideline-based treatment,
proportion of favorable functional outcome
favorable functional outcome defined as modified Rankin Score (mRS) 0-2. The minimum and maximum values of mRS are 0 and 6, respectively; higher score mean a worse outcome
proportion of excellent functional outcome
excellent functional outcome is defined as modified Rankin Score (mRS) 0-1. The minimum and maximum values of mRS are 0 and 6, respectively; higher score mean a worse outcome
ordinal distribution of modified Rankin Score (mRS)
The minimum and maximum values of mRS are 0 and 6, respectively; higher score mean a worse outcome
early neurological deterioration (END)
END is defined as more than 4-point increase in NIHSS within 48±12 hours, but was not a result of intracerebral hemorrhage
early neurological improvement (ENI)
ENI is defined as more than 4-point decrease in NIHSS within 48±12 hours
changes in cortical oxygen saturation determined by near infrared spectroscopy
changes in cortical oxygen saturation determined by near infrared spectroscopy
changes in serum biomarkers
changes in serum biomarkers
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