Evidence map›Paper›PMID 41815317›Full record

ArticleStroke (Hoboken, N.J.)2026

Head Down Tilt 15° to Increase Collateral Flow in Acute Ischemic Stroke: Rationale and Study Protocol of a Multicenter, Randomized, Proof-of-Concept, Phase 2a/b Trial in Patients Treated With Mechanical Thrombectomy (DOWN-SUITE).

Francesco Andrea Pedrazzini, Lorenzo Piergallini, Susanna Diamanti, Enrico Fainardi, Sergio Lucio Vinci, Caterina Sozzi, Matteo Farè, Emanuela Rossi, Francesca Graziano, Francesca Poggetti and 22 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06297863 (Head Down Tilt 15° to Increase Collateral Flow in Acute Ischemic Stroke), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06297863 phase2recruitingnot on this map

Head Down Tilt 15° to Increase Collateral Flow in Acute Ischemic Stroke: a Multicenter, Randomised, Proof of Concept, Phase 2a/b Trial in Patients Treated With Mechanical Thrombectomy

TypeinterventionalSponsorUniversity of Milano BicoccaRan2025 to 2026Enrolled118ConditionsAcute Ischemic StrokeArmsHEAD DOWN TILT -10° to -15°
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Francesco Andrea PedrazziniDepartment of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI) (F.A.P., S.D., C.F., S.B.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0009-0009-7575-2569
Lorenzo PiergalliniDepartment of Neuroscience (L.P., S.D., G.C., P.R., C.F., S.B.), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.ORCID https://orcid.org/0000-0002-2899-1761
Susanna DiamantiDepartment of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI) (F.A.P., S.D., C.F., S.B.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-6201-1536
Enrico FainardiNeuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital (E.F.), University of Florence, Italy.ORCID https://orcid.org/0000-0003-0477-724X
Sergio Lucio VinciNeuroradiology Unit, University of Messina, Italy (S.L.V.).ORCID https://orcid.org/0000-0002-7443-8270
Caterina SozziDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Matteo FarèDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0001-8956-7406
Emanuela RossiDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Francesca GrazianoBiostatistics and Clinical Epidemiology (F.G.), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.ORCID https://orcid.org/0000-0003-1825-3527
Francesca PoggettiDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Gabriele MaininiDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Angela GiglioDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Andrea MagiDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0003-0768-4575
Giulia PederzoliDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Agnese AnzaniDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.
Elisabetta De BernardiDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-8394-0342
Valeria CerinaDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0001-8269-2220
Tae-Hee ChoDepartment of Vascular Neurology, Hospices Civils de Lyon, France (T.-H.C.).ORCID https://orcid.org/0000-0001-8677-2447
Fabien ChauveauLyon Neuroscience Research Center, CNRS, INSERM, University of Lyon 1, France (F.C.).ORCID https://orcid.org/0000-0002-4177-741X
Davide CaroneAcute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (D.C.).ORCID https://orcid.org/0000-0002-1646-6089
Gianpaolo BassoDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-6245-9402
Giuseppe CiterioDepartment of Medicine and Surgery (C. Sozzi, M.F., E.R., F.P., G.M., A.G., A.M., G.P., A.A., E.D.B., V.C., G.B., G.C.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-5374-3161
Cristina SartiNeuroscience Section, NEUROFARBA Department (C. Sarti), University of Florence, Italy.ORCID https://orcid.org/0000-0002-8409-4782
Nicola LimbucciNeuroradiology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy (N.L.).ORCID https://orcid.org/0000-0002-0432-5414
Francesco JanesDepartment of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Italy (F.J.).ORCID https://orcid.org/0000-0003-1534-1409
Carmela CasellaUOSD Stroke Unit, AOU G. Martino, Messina, Italy (C.C., A.T.).ORCID https://orcid.org/0000-0002-5815-4147
Antonio ToscanoUOSD Stroke Unit, AOU G. Martino, Messina, Italy (C.C., A.T.).ORCID https://orcid.org/0000-0002-3995-4827
Simona SaccoDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (S.S.).ORCID https://orcid.org/0000-0003-0651-1939
Danilo ToniDepartment of Human Neurosciences, University of Rome La Sapienza, Italy (D.T.).ORCID https://orcid.org/0000-0003-2735-8427
Paolo RemidaDepartment of Neuroscience (L.P., S.D., G.C., P.R., C.F., S.B.), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.ORCID https://orcid.org/0000-0001-5529-9933
Carlo FerrareseDepartment of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI) (F.A.P., S.D., C.F., S.B.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-7499-6600
Simone BerettaDepartment of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI) (F.A.P., S.D., C.F., S.B.), University of Milano-Bicocca, Monza, Italy.ORCID https://orcid.org/0000-0002-9417-2748

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCollateral blood flow is a critical determinant of successful recanalization in acute ischemic stroke caused by large vessel occlusion. Head down tilt -15° (HDT15), similar to Trendelenburg positioning, is a simple, low-cost positional therapy that may augment cerebral collateral blood flow and penumbral survival. The aim of the study is to assess the safety, feasibility, and efficacy of HDT15 in improving cerebral collateral circulation and clinical outcomes in patients with large vessel occlusion-acute ischemic stroke treated with mechanical thrombectomy (MT).

methodsThe DOWN-SUITE trial (Head Down Tilt 15° to Increase Collateral Flow in Acute Ischemic Stroke) is a multicenter, randomized, open-label, phase 2a/b clinical trial with blinded outcome assessment, conducted across 7 Italian stroke centers. A total of 118 patients with acute ischemic stroke due to M1 segment middle cerebral artery occlusion will be randomized 1:1 in the emergency department to receive HDT15 or standard positioning (head-of-bed 0° to +30°) before and during MT.

resultsThe primary end point is good collateral status (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grade 3-4), assessed on the first angiographic sequence during MT by a blinded imaging core laboratory. Secondary end points include feasibility (proportion maintaining HDT15, admission-to-MT time), safety (symptomatic intracranial hemorrhage, pneumonia, vomiting, neurological deterioration, vital signs), and efficacy (neurological improvement before MT, at 24 hours, and at 7 days or discharge, modified Rankin Scale score at 90 days).

conclusionsThe DOWN-SUITE trial will provide evidence on the acute cerebrovascular effect of HDT15 in large vessel occlusion-acute ischemic stroke, potentially establishing a cost-effective, practice-changing intervention to improve collaterals for global stroke care. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06297863.

Indexed as

feasibility studieshead down tiltischemic strokeItalythrombectomy

Identifiers

PMID41815317
PMCPMC12959440

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