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Updated: Jul 28, 2026
12:15
Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
Published on: February 17, 2013
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Head Positioning for Stroke Blood Flow Augmentation Assisting Reperfusion Therapies Study
Rudy Goh1, Edmund Cheong2, Lizzie Dodd2
1Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia, rudy.goh@sa.gov.au.
Cerebrovascular Diseases (Basel, Switzerland)
|July 13, 2025
Summary
Head-down (Trendelenburg) positioning modestly improved brain perfusion in acute ischemic stroke patients with large vessel occlusion. This technique was generally well-tolerated and may benefit those with delayed reperfusion.
Area of Science:
- Neurology
- Medical Imaging
- Stroke Research
Background:
- Cerebral perfusion in acute ischemic stroke is critical for patient outcomes.
- The efficacy of head-lowered positions to improve brain perfusion remains uncertain.
- Quantitative computed tomography perfusion (CTP) allows objective measurement of ischemic tissue.
Purpose of the Study:
- To investigate if 20-degree Trendelenburg positioning improves cerebral perfusion in acute ischemic stroke patients.
- To assess changes in ischemic lesion volume using CTP.
- To evaluate the safety and tolerability of Trendelenburg positioning.
Main Methods:
- Prospective, single-arm study of 25 acute ischemic stroke patients (≥60 years) with large vessel occlusion (LVO).
- CTP was performed in routine position and after 5 minutes of 20-degree Trendelenburg positioning.
- Clinical severity (NIHSS) and blood pressure were monitored; Trendelenburg was continued for 24h if reperfusion was suboptimal.
Main Results:
- Median delay time >3s lesion volume decreased by 18 mL with Trendelenburg positioning (p=0.0027).
- 60% of patients showed significant lesion volume reduction; 7 received continued Trendelenburg positioning.
- Systolic blood pressure remained stable, and head positioning did not alter clinical severity (NIHSS).
- Trendelenburg positioning was well-tolerated with no serious adverse events.
Conclusions:
- Head-down (Trendelenburg) positioning offers a modest improvement in penumbral perfusion for acute LVO ischemic stroke.
- This positioning is generally well-tolerated and safe.
- Further investigation is warranted, particularly in patients with delayed or failed reperfusion.
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