Head position after endovascular treatment for large vessel occlusion stroke: does it matter?

Stroke is a leading cause of death and disability worldwide. Despite improving patient outcomes, reperfusion treatments are time dependent and not universally available. Head positioning is a simple, low cost intervention with a compelling physiological rationale,1 but randomised trials have not demonstrated functional benefit.234 Current guidelines recommend head position based on the individual, rather than routinely keeping patients in either flat or upright head positions.567 However, earlier trials focused on optimising head position to improve cerebral perfusion before reperfusion of the ischaemic penumbra. Whether there is a preferred head position after successful reperfusion remains unclear, especially in those with major strokes where head elevation may attenuate oedema progression.In a linked study (doi:10.1136/bmj-2026-100363), Yuan and colleagues report the HeadSOAR trial, which aimed to determine optimal head position after successful reperfusion.8 HeadSOAR was an investigator led, multicentre, randomised, open label trial with blinded endpoint assessment conducted across 67 stroke centres in China….