Association between Responsible Artery Stenosis Rate and Efficacy of Head-Down Position Therapy in Moderate Acute Ischemic Stroke: A Subgroup Analysis of the HOPES 2 Trial

doi:10.3969/j.issn.1673-5765.2026.07.004

Abstract

Abstract: Objective Based on data from the head-down position for acute ischemic stroke with large artery atherosclerosis (HOPES 2) trial, this study aimed to investigate the impact of different responsible artery stenosis rates on the efficacy of head-down position therapy in patients with moderate acute ischemic stroke.
Methods This study was a subgroup analysis of the HOPES 2 trial. Patients with moderate (baseline NIHSS score 6-16) acute ischemic stroke were enrolled and divided into three subgroups according to the responsible artery stenosis rate: moderate stenosis (50%-69%), severe stenosis (70%-99%), and occlusion (100%). Within each subgroup, patients were further categorized into those receiving head-down position therapy and those receiving routine therapy. Binary logistic regression was used to examine the effects of different treatments on patient outcomes, including favorable outcome (defined as 90-day mRS scores 0-2) and excellent outcome (defined as 90-day mRS scores 0-1). A generalized linear model was used to assess the effects of different treatments on 12-day NIHSS score improvement from baseline.
Results A total of 89 patients with moderate acute ischemic stroke were included, with a median age of 62 (57-71) years, and 64 (71.9%) were male. Among these patients, 42 received head-down position therapy and 47 received routine therapy. There were 17 patients in the moderate stenosis subgroup (8 treated with head-down position therapy, 9 with routine therapy), 22 patients in the severe stenosis subgroup (11 treated with head-down position therapy, 11 with routine therapy), and 50 patients in the occlusion subgroup (23 treated with head-down position therapy, 27 with routine therapy). In the severe stenosis subgroup, compared with routine therapy, head-down position therapy showed a trend toward benefit in terms of 90-day favorable outcome, but the difference was not statistically significant [adjusted OR (aOR) 12.354, 95%CI 0.762-234.042, P=0.076], a higher proportion of 90-day excellent outcome (aOR 25.471, 95%CI 1.028-630.954, P=0.048), and greater improvement in 12-day NIHSS score from baseline [adjusted mean difference (aMD) 3.637, 95%CI 1.027-6.246, P=0.006]. In the occlusion subgroup, head-down position therapy showed a trend toward improvement in 12-day NIHSS score from baseline (aMD 3.700, 95%CI -0.385-7.786, P=0.076). In the moderate stenosis subgroup, no significant differences were found between treatments for any outcome. In the occlusion subgroup, early neurological deterioration at 48 hours occurred in 2 patients receiving standard care, and all‑cause death within 90 days was observed in 5 patients. In the severe stenosis subgroup, all‑cause death within 90 days occurred in 1 patient receiving head‑down position therapy.
Conclusions The neuroprotection effect of head-down position therapy in patients with moderate acute ischemic stroke may be associated with the responsible artery stenosis rate, with the most pronounced benefit observed in those with severe stenosis, suggesting that the responsible artery stenosis rate may serve as a reference for individualized positional intervention decisions.

Key words: Acute ischemic stroke; Head-down position; Responsible artery stenosis rate; Neuroprotection

摘要： 目的基于大动脉粥样硬化型急性缺血性卒中的头低位治疗（head-down position for acute ischemic stroke with large artery atherosclerosis，HOPES 2）试验数据，探讨不同责任血管狭窄率对头低位治疗中度急性缺血性卒中患者疗效的影响。
方法本研究为HOPES 2试验的亚组分析，纳入中度（基线NIHSS评分6～16分）急性缺血性卒中患者，并根据责任血管狭窄率分为中度狭窄（50%～69%）、重度狭窄（70%～99%）和闭塞（100%）3个亚组。各亚组内根据治疗方法进一步分为头低位治疗和常规治疗。采用二元logistic回归分析探讨不同治疗方法对患者预后［良好预后（90 d mRS评分0～2分）和极佳预后（90 d mRS评分0～1分）］的影响；采用广义线性模型分析不同治疗方法对12 d NIHSS评分较基线改善情况的影响。
结果本研究共纳入中度急性缺血性卒中患者89例，中位年龄为62（57～71）岁，男性64例（71.9%），接受头低位治疗42例，常规治疗47例。中度狭窄亚组17例（头低位治疗8例，常规治疗9例）；重度狭窄亚组22例（头低位治疗11例，常规治疗11例）；闭塞亚组50例（头低位治疗23例，常规治疗27例）。在重度狭窄亚组中，与常规治疗相比，头低位治疗在90 d良好预后方面呈获益趋势，但差异无统计学意义［校正OR（adjusted OR，aOR）12.354，95%CI 0.762～234.042，P=0.076］，90 d极佳预后的比例更高（aOR 25.471，95%CI 1.028～630.954，P=0.048），12 d NIHSS评分较基线改善更优［校正均数差（adjusted mean difference，aMD）3.637，95%CI 1.027～6.246，P=0.006］。在闭塞亚组中，头低位治疗在12 d NIHSS评分较基线改善方面呈获益趋势（aMD 3.700，95%CI -0.385～7.786，P=0.076）。中度狭窄亚组不同治疗方法对各结局指标的影响均无统计学意义。闭塞亚组接受常规治疗患者中，48 h早期神经功能恶化2例，发病90 d全因死亡5例；重度狭窄亚组接受头低位治疗患者中，发病90 d全因死亡1例。
结论头低位治疗对中度急性缺血性卒中患者的脑细胞保护作用或与责任血管狭窄率相关，其中重度狭窄患者获益最为显著。责任血管狭窄率或可作为个体化体位干预决策的参考指标。

关键词: 急性缺血性卒中; 头低位; 责任血管狭窄率; 脑细胞保护

CLC Number:

WU Qiong, ZHANG Nannan, ZHANG Yina, CHEN Huisheng. Association between Responsible Artery Stenosis Rate and Efficacy of Head-Down Position Therapy in Moderate Acute Ischemic Stroke: A Subgroup Analysis of the HOPES 2 Trial[J]. Chinese Journal of Stroke, 2026, 21(7): 814-822.

吴琼, 张楠楠, 张依娜, 陈会生. 中度急性缺血性卒中责任血管狭窄率与头低位治疗效果的关系：基于HOPES 2试验的亚组分析[J]. 中国卒中杂志, 2026, 21(7): 814-822.

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URL: https://www.chinastroke.org.cn/EN/10.3969/j.issn.1673-5765.2026.07.004

https://www.chinastroke.org.cn/EN/Y2026/V21/I7/814

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