Head Position Before Surgery May Improve Neurological Function in Stroke Patients

Patients with large-vessel ischemic stroke caused by a blood clot whose heads are positioned at a 0-degree angle prior to surgery to remove the clot have significantly improved neurological function compared with those patients whose heads are elevated at a 30-degree angle, according to preliminary late-breaking science presented at the American Stroke Association’s International Stroke Conference 2024.

“Many thrombectomy patients have delays until the procedure can be started, whether due to slow internal hospital processes, multiple patients arriving at the same time, or if the patient needs to be transferred to another hospital,” said lead study researcher Anne W. Alexandrov, PhD, a professor of nursing and neurology at the University of Tennessee Health Science Center in Memphis, via a press release. “Optimizing blood flow to the brain while patients are waiting for surgery is essential to minimize the risk of neurological deficits and ultimately disability.”

In the randomized, clinical Zero Degree Head Positioning in Acute Large Vessel Ischemic Stroke, or ZODIAC, trial, researchers used the National Institutes of Health Stroke Scale (NIHSS) to assess 92 patients with acute ischemic stroke caused by large-vessel occlusion from 12 stroke centers in the United States. The goal of the analysis was to discern if patients’ conditions remained stable or worsened depending on whether they were set with 0-degree head positioning or 30-degree head positioning before thrombectomy surgery. The researchers also explored whether there would be differences in the NIHSS score at 24 hours after surgery and 7 days after time of discharge.

Interim results showed that 0-degree head positioning before thrombectomy surgery resulted in greater stability and/or clinical improvement prior to surgery. Surprisingly, the results also showed that at both 24 hours after surgery and 7 days after discharge, patients whose heads were set at a 0-degree angle before surgery had fewer neurological deficits compared with patients whose heads were set at a 30-degree angle.

“Our findings suggest that gravitational force can play an important role in improving blood flow temporarily while patients are waiting for surgery,” Dr. Alexandrov said. “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.”