Head-down positioning before clot removal in large vessel stroke
Tests head-down positioning before endovascular treatment in adults with large vessel ischemic stroke.
Plain-language title generated from the registry record
Registry title: Head dOwn Position Before Endovascular Treatment for Large veSsel Occlusion (HOPES5)
Key facts
- Where
- Shenyang, ChinaSee the site
Where in China
- Hui-Sheng ChenShenyang, ChinaTaking people
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- General Hospital of Shenyang Military Region
- Trial code
- NCT07172789
- Record updated
- 18 September 2026
- Original description
Recent studies suggest that head-down positioning (HDP) intervention may improve outcomes in ischemic stroke. In the era of reperfusion therapy, a key protective strategy is to administer neuroprotective interventions before recanalization to reduce the loss of the ischemic penumbra, thereby salvaging more penumbral tissue after revascularization and ultimately improving clinical outcomes. Based on this concept, and considering the neuroprotective effects of HDP, the investigators hypothesize that HDP intervention prior to endovascular therapy (EVT) in patients with large vessel occlusion could improve clinical outcomes. This hypothesis is further supported by a recent clinical study (NCT03728738), which demonstrated that compared to a sitting up position (30°), a flat supine position (0°) before EVT significantly reduced the incidence of neurological deterioration prior to the procedure. Building on the above rationale, this trial aims to investigate the efficacy and safety of HDP intervention prior to EVT in patients with large vessel occlusion.Read full original descriptionShow less
Head dOwn Position Before Endovascular Treatment for Large veSsel Occlusion (HOPES5): a Prospective, Randomized, Open Label, Blinded-end Point, Multi-center Study
Recent studies suggest that head-down positioning (HDP) intervention may improve outcomes in ischemic stroke. In the era of reperfusion therapy, a key protective strategy is to administer neuroprotective interventions before recanalization to reduce the loss of the ischemic penumbra, thereby salvaging more penumbral tissue after revascularization and ultimately improving clinical outcomes. Based on this concept, and considering the neuroprotective effects of HDP, the investigators hypothesize that HDP intervention prior to endovascular therapy (EVT) in patients with large vessel occlusion could improve clinical outcomes. This hypothesis is further supported by a recent clinical study (NCT03728738), which demonstrated that compared to a sitting up position (30°), a flat supine position (0°) before EVT significantly reduced the incidence of neurological deterioration prior to the procedure. Building on the above rationale, this trial aims to investigate the efficacy and safety of HDP intervention prior to EVT in patients with large vessel occlusion.
Inclusion: Age ≥ 18 years; Patients with acute large vessel occlusion scheduled for endovascular thrombectomy within 24 hours of symptom onset; Baseline National Institute of Health Stroke Scale (NIHSS) ≥ 6; Expected waiting time from randomization to femoral artery puncture is more than 30 minutes; ASPECTS/pc-ASPECTS score ≥ 6 on baseline non-contrast CT or DWI; Modified Rankin Scale score before stroke onset ≤ 1; Signed informed consent by patient or their legally authorized representative.
Exclusion: Hemorrhagic stroke: cerebral hemorrhage, subarachnoid hemorrhage; Severe hypertension before randomization (systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg); Cardiac insufficiency (NYHA Class ≥II); The estimated life expectancy is less than 6 months due to other serious diseases; Other conditions unsuitable for this clinical study assessed by researcher; Severe hepatic or renal dysfunction, increase in ALT or AST (more than 2 times of upper limit of normal value), increase in serum creatinine (more than 1.5 times of upper limit of normal value) or requiring dialysis; Pregnancy, plan to get pregnant or during lactation; Patients at significant risk of aspiration (e.g., obvious nausea and vomiting).