The Impact of Heads Up Testing on Thrombectomy for Acute Ischemic Stroke

You do realize survivors want prevention of early neurological deterioration rather than this USELESS PREDICTION?  I'd have you all fired!

The most likely reason for END is not stopping the 5 causes of the neuronal cascade of death in the first week letting hundreds of millions to billions of neurons DIE! AND YOU DON'T KNOW THAT? My God, the complete incompetence out there!

The Impact of Heads Up Testing on Thrombectomy for Acute Ischemic Stroke

Mallory BlackwoodCharles BeamanLatisha SharmaDavid S Liebeskind^*

• University of California, Los Angeles, Los Angeles, United States

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The Heads Up test, initially described in 2017, offers a potential tool for assessing likelihood of collateral failure in patients with acute large vessel occlusion (LVO) but low or resolving NIH who may become candidates for mechanical thrombectomy (MT). By raising the head of bed and performing serial exams (Heads Up test), detection of early symptomatic worsening may indicate vulnerability of collateral blood supply. The present study aims to examine the practical applications and outcomes of the Heads Up test in one institution over nine years by analyzing 15 consecutive cases of documented Heads Up testing. Our findings suggest that the Heads Up test can provide valuable guidance in treatment decisions, but further data is needed to refine its criteria and applicability in the evolving neurointerventional practice. Abbreviations: MT (mechanical Thrombectomy) LVO (Large Vessel Occlusion) NIHSS (National Institutes of Health Stroke Scale) EHR (Electronic Health Record) eTICI (expanded Thrombolysis in Cerebral Infarction scale) IR (interventional radiology)

Keywords: ischemic stroke (acute), Mechanical thrombectomy, Low NIHSS, Collateral perfusion, Large vessel occlusion

Received: 15 Apr 2025; Accepted: 26 Jun 2025.

Copyright: © 2025 Blackwood, Beaman, Sharma and Liebeskind. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: David S Liebeskind, University of California, Los Angeles, Los Angeles, United States

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.