Trendelenburg Position for Acute Anterior Circulation Ischemic Stroke With Large Artery Atherosclerosis Etiology (HOPES 3)

Inclusion criteria

• 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);
• Anterior circulation stroke (internal carotid artery, M1 or M2 of middle cerebral artery);
• First stroke onset or past stroke without obvious neurological deficit (mRS≤2);
• Signed informed consent.

Exclusion criteria

• 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;
• Serious comorbidity, such as liver or kidney insufficiency, malignant tumor, etc;
• Other stroke etiologies, such as cardiogenic embolism, arteritis, arterial dissection, moyamoya disease, etc;
• Previous history of intracerebral hemorrhage within 1 year;
• Any contraindication to head-down position (e.g. active vomiting, pneumonia, uncontrolled heart failure);
• Planned carotid or intracranial revascularization within 3 months;
• Severe uncontrolled hypertension (systolic blood pressure over 180mmHg or diastolic blood pressure over 100 mmHg);
• Cardiac insufficiency (NYHA Class ≥II);
• Pregnant or lactating women;
• Comorbidity with other serious diseases;
• Participating in other clinical trials within 3 months;
• Patients not suitable for the study considered by researcher.