Patients with acute ischemic stroke who have large vessel occlusion have shown an impressive benefit from having their head lowered to a flat position until they are able to undergo thrombectomy in a new landmark randomized clinical trial.
Zero-degree head positioning is a safe and effective strategy to optimize blood flow to the brain until the thrombectomy can be performed, she concluded, and it should be considered the standard of care for patients with stroke prior to thrombectomy. "Often with thrombectomy, there are delays, even under the best of circumstances when the patients present to a comprehensive stroke center, so this is a nice bridge to increase perfusion to the ischemic brain while waiting for the artery to be opened," McCullough added.
Results showed that the primary endpoint of early neurologic deterioration of 2 points or more on the NIHSS score occurred in just 1 of 45 patients in the group who were laid flat compared with 26 of 47 patients of the group whose heads were raised to 30 degrees was considered. This occurred again in just one patient in the zero degrees group vs 20 patients in the 30 degrees group and at 7 days or discharge in 87% vs 68% scores that appears to favor the zero degrees group, Alexandrov noted.
She pointed out that the HEADPOST trial did not use imaging to identify the types of patients with stroke included. "So, their data do not answer the question of head position for large vessel occlusion strokes," she said. "But once the patient goes into the CT scanner, within 30 seconds we should know whether there is blood on the scan or not, and within the next 3 or 4 minutes, we are going to know if they have a large vessel occlusion. The patient is flat in the CT scanner for those few minutes, and we are now saying if a large vessel occlusion is seen on the scan, then they should be kept flat until thrombectomy is performed.
Source: Law Daily Report (lawdailyreport.net)