Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundHead down position (HDP) shows potential benefits in acute ischemic stroke.
Although −20° HDP appears safe, feasible, and potentially beneficial in patients with large artery atherosclerosis without reperfusion therapy, its value before endovascular treatment (EVT) in acute large vessel occlusion (LVO) stroke remains unknown. This trial aims to investigate the efficacy and safety of −20° HDP in patients with acute large vessel occlusion stroke before planned EVT.MethodsThe HOPES5 (Head Down Position Before Endovascular Treatment for Large Vessel Occlusion) trial is a prospective, randomized, open label, blinded‐end point, multicenter study.
Eligible patients with large vessel occlusion will be randomized 1:1 to −20° HDP or a flat (0°) head position before EVT, alongside standard guideline‐based care. Primary outcome is early neurological improvement, defined as ≥4 National Institutes of Health Stroke Scale score reduction within 24 hours post EVT.
Safety outcomes are HDP‐related adverse events. Based on a prospective cohort, the proportion of early neurological improvement after EVT was ∼31%.
Journal of the American Heart Association published a clinical update in Cardiology on 04 Mar 2026.
The item focuses on Head Down Position Before Endovascular Treatment for Large Vessel Occlusion: Clinical Trial Design.
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