How do you decide on head-of-bed positioning after mechanical thrombectomy for acute stroke?

First, there is some evidence that HOB positioning is related to deterioration/improvement before endovascular thrombectomy (EVT) from the ZODIAC trial.

Second, safety comes first. Follow your ABCs. If the airway is ok, the patient does not develop orthopnea with a supine position, and the BP is ok ...

Based on the ZODIAC trial, there appears to be a benefit to keeping the patients flat before thrombectomy. In this trial, flat patients have less neurologic deterioration and less mortality than patients at 30 degrees. This makes sense because there is a clot in the brain that is reducing blood flow...

Agree with what's been stated, and from a procedural standpoint, my approach is tied to reperfusion grade. For eTICI 2c or 3, head-of-bed positioning would not play a significant role. eTICI 2b is a gray zone. And for eTICI 2a or less, I have a lower threshold to lay flat as tolerated. Regardless of...