# The impact of Heads Up testing on thrombectomy for acute ischemic stroke

## TL;DR

This study explores how the Heads Up test helps in deciding mechanical thrombectomy for stroke patients with uncertain symptoms.

## Contribution

The study evaluates the real-world use and outcomes of the Heads Up test over nine years at a single institution.

## Key findings

- The Heads Up test can guide treatment decisions for stroke patients with low NIH scores.
- Early symptomatic worsening during the test may indicate poor collateral blood supply.
- More data is needed to refine the test's criteria and application.

## Abstract

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 9 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.