Zero Degree Head Positioning Before Thrombectomy Can Improve Neurologic Function According to New Study

People with large vessel ischemic stroke who were scheduled to receive thrombectomy experienced improved neurological function when their heads were positioned at 0 degrees elevation prior to surgery compared with positioning at 30 degrees. The benefit of 0-degree head positioning is thought to result from increased gravitational blood flow through arteries. As the standard of care prior to thrombectomy is to position patients’ heads at a 30-degree incline, this finding suggests that changes to presurgical procedures may be beneficial for patient outcomes. Results were based on an analysis of interim data from the ZODIAC clinical trial (NCT03728738) presented at the American Stroke Association’s International Stroke Conference 2024.

ZODIAC was a randomized clinical trial including 92 participants from 12 stroke centers in the United States with large artery occlusion. Participants were randomized to have their heads positioned at 0 or 30 degrees prior to thrombectomy. The primary outcome measure of the study was early neurological deterioration as assessed by a ≥2-point worsening on the National Institute of Health Stroke Scale (NIHSS) evaluated every 10 minutes from initiation of positioning until surgery.

According to results of the interim analysis, 0-degree head positioning was associated with increased stability and clinical improvement prior to surgery compared with 30-degree head positioning. Secondary outcome measures assessed also showed longer-term benefits of 0-degree head incline, with patients positioned at a flat angle showing decreased neurological deficits at 24 hours and 7 days after discharge. The Data and Safety Monitoring Board stopped enrollment of the study due to the demonstrated efficacy of 0-degree head positioning.

“Our findings suggest that gravitational force can play an important role in improving blood flow temporarily while patients are waiting for surgery,” said lead study researcher Anne W. Alexandrov, PhD. “Zero-degree head positioning is a safe and effective strategy to optimize blood flow to the brain until the thrombectomy can be performed, and it should be considered the standard of care for stroke patients prior to thrombectomy.”

The authors of this study are affiliated with the University of Tennessee Health Science Center.