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OA

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.