Head Down Tilt 15° to Increase Collateral Flow in Acute Ischemic Stroke

The DOWN-SUITE study is multicenter, randomised, controlled, open-label clinical trial with blinded outcome assessment comparing collateral status in patients with acute ischemic stroke treated with an in-hospital application of head down tilt -10° to -15° (HDT15) versus usual positioning (0° to +30°) before endovascular mechanical thrombectomy. This study will involve adult patients who are eligible for mechanical thrombectomy and who have acute ischemic stroke due to left or right middle cerebral artery occlusion (M1 segment). The investigators hypothesise that HDT15, applied in acute ischemic stroke patients with a large vessel occlusion, will improve collateral circulation, prolong the survival of the ischemic penumbra and improve the clinical benefit from mechanical thrombectomy compared with standard of care (usual positioning 0° to +30°).

NCT Number	NCT06297863
Lead Sponsor	University of Milano Bicocca Collaborators: Fondazione IRCCS San Gerardo dei Tintori, Azienda Ospedaliero-Universitaria Careggi, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Azienda Ospedaliero Universitaria, Santa Maria della Misericordia di Udine, Italy, Università degli Studi dell'Aquila, Azienda Ospedaliero Universitaria Policlinico Umberto I, Roma
Conditions	Acute Ischemic Stroke
Enrollment	118 participants
Start Date	2025-03-01
Primary Completion	2026-09-30 (estimated)
Study Completion	2026-12-31 (estimated)
Updated on ClinicalTrials.gov	2026-05-06