ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicUnderstanding the No-Reflow Phenomenon in Acute Ischemic StrokeView all 3 articles
Very early tilt-table verticalization unmasks impaired cerebral autoregulation within 24h after endovascular thrombectomy. A transcranial Doppler study
Provisionally accepted
Julian Deseö1,2
Yannik Rottenberger1,3
Theodor Pipping1
Anne Schwarz1,4Aurelia Lehmann1
Janne Marieke Veerbeek1,5
Susanne Wegener1,2
Andreas R Luft1,3Jeremia P.O. Held1,6
Christoph Globas1*- 1Department of Neurology, University Hospital Zurich, Zürich, Switzerland
- 2Zentrum fur Neurowissenschaften Zurich, Zürich, Switzerland
- 3cereneo Vitznau, Vitznau, Switzerland
- 4University of Southern California, Los Angeles, United States
- 5Luzerner Kantonsspital, Lucerne, Switzerland
- 6NeuroZentrum Bellevue, Zürich, Switzerland
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Introduction: Impaired cerebral autoregulation in the acute phase after ischemic stroke may compromise cerebral perfusion during very early mobilization, posing a risk for secondary injury. Methods: This observational cross-sectional study investigated the mechanistic response of cerebral and systemic hemodynamics during progressive tilt-table verticalization in 25 patients within 24 hours post-thrombectomy and 31 healthy age-matched controls. Middle cerebral artery blood flow velocity (CBFV) was continuously recorded via transcranial Doppler across six full-body tilt positions (−5° to 70°), alongside blood pressure, heart rate, and oxygen saturation. Results: CBFV declined progressively with increasing tilt in both groups (p < 0.001), but the reduction at 70° was significantly greater in stroke patients (p = 0.007), indicating compromised cerebral pressure-flow regulation. Diastolic blood pressure, linked to systemic vascular resistance, increased with tilt in controls but failed to rise in stroke patients, remaining significantly lower throughout. Discussion: Our results suggest impairments in cerebral and systemic vascular control mechanisms in acute stroke patients post thrombectomy. These results provide further insight into the physiological constraints limiting early verticalization and underscore the value of real-time CBFV monitoring as a potential biomarker for autoregulatory integrity. Incorporating individualized hemodynamic profiling may enhance safety and precision in early stroke rehabilitation protocols. Trial registration at ClinicalTrials.gov (Identifier: NCT04573114)
Keywords: Blood Pressure, cerebral autoregulation, Doppler ultrasound, ischemic stroke, very early mobilization
Received: 21 Sep 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Deseö, Rottenberger, Pipping, Schwarz, Lehmann, Veerbeek, Wegener, Luft, Held and Globas. 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: Christoph Globas
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