Positioning patients with large vessel ischemic stroke (attributable to clots) with their heads flat (0 degrees) before surgery to remove a blood clot resulted in significant improvement in neurological function compared with patients whose heads were elevated (at a 30-degree angle), in keeping with preliminary findings. groundbreaking science presented today on the American Stroke Association’s 2024 International Stroke Conference. The meeting, held in person in Phoenix on February 7–9, 2024, is the world’s premier meeting for researchers and clinicians focused on stroke science and brain health.

Large vessel occlusion is a style of ischemic stroke through which a serious artery within the brain is blocked. A surgery called thrombectomy removes the blood clot to revive blood flow and reduce the chance of death or everlasting brain damage, including potential lack of neurological function.

Many thrombectomy patients experience delays in starting the procedure, whether resulting from slow internal processes within the hospital, multiple patients arriving at the identical time, or the necessity to transfer the patient to a different hospital. Optimizing blood flow to the brain while patients await surgery is important to reduce the chance of neurological deficits and ultimately disability.”

Anne W. Alexandrov, Ph.D., Principal Investigator, Professor of Nursing and Neurology, University of Tennessee Health Science Center at Memphis

Currently, hospital beds for stroke patients awaiting thrombectomy surgery are typically arrange with the top of the bed at 30 degrees, a slight angle, Aleksandrov said. Nonetheless, pilot studies conducted by Aleksandrov’s team showed that when the top of the bed is flat at a 0-degree angle, thrombectomy patients profit from increased gravitational blood flow through the narrowed/blocked artery and more open collateral arteries throughout the procedure.

On this randomized clinical trial called Zero Degree Head Positioning in Acute Large Vessel Ischemic Stroke (ZODIAC), researchers used the National Institutes of Health Stroke Scale (NIHSS), which assesses consciousness, vision, speech, motor strength and sensory loss, to guage patients after stroke with occlusion of huge vessels, acute ischemic stroke. They compared whether patients remained stable or worsened depending on whether or not they had a 0-degree head position or a 30-degree head position before thrombectomy.

Stroke patients’ baseline NIHSS scores were measured at 0 degrees immediately after neuroimaging after which randomly positioned at 0 or 30 degrees of head position. Patients underwent repeated NIHSS assessments every 10 minutes until thrombectomy, and the ultimate NIHSS assessment was assessed immediately before they were placed on the operating table.

An interim evaluation showed that a 0-degree head position prior to thrombectomy resulted in greater preoperative stability and/or clinical improvement based on repeated NIHSS scores in stroke patients compared with patients with a 30-degree head position.

The investigators also tested whether there could be differences in NIHSS scores 24 hours after surgery and seven days after discharge (whichever got here first), but they didn’t anticipate finding a difference because thrombectomy alone dramatically improves patient outcomes. They were surprised to search out that each 24 hours after surgery and seven days after discharge, patients with a 0-degree head position had fewer neurological deficits on the NIHSS in comparison with patients whose head was in a 30-degree head position before surgery. .

“Within the three months after surgery, there have been no differences in patient outcomes in either group, but what’s exciting is that we were capable of discharge patients with lesser disabilities who required rehabilitation,” Alexandrov said.

Resulting from the effectiveness of 0-degree head positioning in stroke patients awaiting thrombectomy, the trial’s Data and Safety Monitoring Committee paused enrollment on this trial on November 1, 2023.

“Our findings suggest that gravity may play a vital role in temporarily improving blood flow in patients awaiting surgery,” Aleksandrov said. “Zero-degree head positioning is a secure and effective strategy for optimizing cerebral blood flow until thrombectomy and ought to be considered the usual of take care of stroke patients prior to thrombectomy.”

Study background and details:

• The study included 92 patients from 12 stroke centers in the US
• Patient demographic information can be presented throughout the presentation.
• Aleksandrov noted that 0-degree head positioning is NOT a treatment for stroke; it is a approach to preserve brain function by optimizing blood flow until thrombectomy is performed. “It is a rescue maneuver, not a treatment.”