Stroke Thrombectomy: Head Position & Outcomes
- A new study indicates that keeping a stroke patient's head flat, at a 0° angle, before a thrombectomy significantly lowers the risk of neurologic decline and death.
- The ZODIAC trial, a prospective, multicenter study, followed 92 patients from 2018 to 2023.
- Researchers assessed National Institutes of Health Stroke Scale (NIHSS) scores every 10 minutes until thrombectomy began.
Discover how a simple adjustment in patient positioning can significantly impact outcomes for stroke patients undergoing thrombectomy.A study reveals that placing a patient’s head flat,at a 0° angle,before the procedure dramatically reduces the risk of neurologic decline and mortality. This groundbreaking research compared the conventional 30° head elevation to flat positioning, highlighting the critical role pre-thrombectomy head positioning plays during stroke treatment. The ZODIAC trial demonstrated that the 0° group saw notably reduced instances of early and severe neurologic deterioration, as well as a lower all-cause mortality rate. News Directory 3 keeps you informed. Learn more about this crucial aspect of stroke care.Discover what’s next in stroke treatment.
Flat Head Positioning Improves Outcomes in Stroke Patients
Updated June 18, 2025
A new study indicates that keeping a stroke patient’s head flat, at a 0° angle, before a thrombectomy significantly lowers the risk of neurologic decline and death. The research compared this positioning with the conventional 30° head elevation for adults experiencing large vessel occlusion (LVO) stroke.
The ZODIAC trial, a prospective, multicenter study, followed 92 patients from 2018 to 2023. The average age of participants was 67; 52% were men. All had LVO stroke confirmed by CT angiography and were eligible for thrombectomy within 24 hours of the event. Patients were randomly assigned to either 0° or 30° head positioning before the procedure.
Researchers assessed National Institutes of Health Stroke Scale (NIHSS) scores every 10 minutes until thrombectomy began. The primary focus was early neurologic deterioration,defined as a worsening of ≥ 2 NIHSS points before thrombectomy. Secondary outcomes included severe neurologic deterioration (worsening of ≥ 4 NIHSS points), hospital-acquired pneumonia, and death from any cause within three months. The study highlights the critical role head positioning plays in patient outcomes, emphasizing the role of proper care and the role of innovative approaches to stroke treatment.
“Results suggest that patients awaiting thrombectomy treatment for LVO stroke should be positioned with the head at 0° to ensure clinical stability and prevent worsening,” the investigators wrote.
the study revealed that early neurologic deterioration occurred more frequently in the 30° group (55%) compared to the 0° group (2%). Severe neurologic deterioration also followed this trend (20 patients vs. 1 patient). The all-cause mortality rate at 90 days was significantly lower in the 0° group (4%) than in the 30° group (22%). Furthermore, more patients in the 0° group showed neurologic enhancement 24 hours post-thrombectomy (87% vs 60%). No patients in either group developed hospital-acquired pneumonia.
“We posit that 0° head positioning is a bridging maneuver to thrombectomy, protecting ischemic tissue and possibly reducing infarct progression before definitive treatment,” they added.
What’s next
Further research with larger sample sizes is needed to confirm these findings and explore the optimal head positioning strategies for stroke patients before thrombectomy. The study,however,suggests a simple adjustment in patient care could significantly improve outcomes.