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STAND: Ultrasound of Cerebral Blood Flow During First Verticalization in Acute Stroke-A Prospective Case-Control
Laurine Bedoucha1, Claire Gobron1,2, Fabrice Vallee1,3
1Hôpital Lariboisière AP-HP, Université Paris Cité, FHU NeuroVasc, StrokeLink, Paris, France.
Brain and Behavior
|September 22, 2025
Summary
Early mobilization after ischemic stroke may reduce cerebral blood flow in patients with carotid stenosis. This highlights the need for personalized strategies considering vascular and systemic factors for safe patient recovery.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Critical Care Medicine
Background:
- Optimal timing for patient mobilization in acute ischemic stroke is uncertain.
- Previous studies conflict and often overlook arterial stenosis effects on cerebral blood flow.
- Carotid stenosis significantly impacts intracranial hemodynamics during mobilization.
Purpose of the Study:
- To investigate if early sitting affects intracranial hemodynamics in acute ischemic stroke patients.
- To assess the influence of significant carotid stenosis on cerebral blood flow during early mobilization.
Main Methods:
- Prospective, bi-centric, case-control observational study (NCT04180826).
- Continuous, non-invasive monitoring of cerebral and systemic hemodynamics during transition from supine to sitting.
- Cases: ischemic stroke with homolateral carotid stenosis >50% (NASCET criteria).
- Primary outcome: >10% reduction in mean flow velocity (MFV) in the homolateral middle cerebral artery (MCA).
Main Results:
- A >10% MFV drop occurred in 53% of cases (carotid stenosis) vs. 5% of controls (p=0.012).
- Cases with MFV drop showed no compensatory systemic response (blood pressure/heart rate).
- Shorter time from stroke onset to sitting and presence of carotid stenosis independently predicted MFV decrease.
- Lower hemoglobin and higher BNP levels were associated with MFV decline in cases.
Conclusions:
- Early sitting in acute ischemic stroke is linked to significant MFV reductions in patients with carotid stenosis.
- Impaired systemic hemodynamic adaptation may explain these findings.
- Individualized mobilization strategies considering vascular and systemic factors are crucial.
