Abstract Number: Esoc2026a1375 Elevated Leg Positioning for Acute Moderate Ischemic Stroke: The Leg-Up Pilot Study

Background and aims Optimization of cerebral perfusion through nonpharmacological hemodynamic interventions, particularly patient positioning, has shown promise as a cost-effective strategy for improving acute ischemic stroke (AIS) outcomes; however, current evidence remains inconsistent. We aimed to assess the feasibility, safety, and potential clinical benefit of elevated leg positioning (ELP) in AIS. Methods This prospective, randomized, open-label, and blinded-endpoint pilot study included moderate anterior circulation AIS patients with probable large artery atherosclerosis etiology who were ineligible for reperfusion therapy. Eligible patients were randomized (1:1) to receive either 30° ELP initiated within 24 hours of ictus, or standard care. Primary endpoints were intervention feasibility and safety, assessed by protocol adherence and the frequency of prespecified positioning-related adverse events. Secondary endpoints were 90-day favorable functional outcomes (modified Rankin Scale score: 0-2), and 30-day all-cause mortality. Results Fifty patients were randomized (n=25 per group). Protocol adherence was 96.0% (24/25) in the intervention group, with one patient unable to tolerate ELP. Three patients (6.0%) were lost to follow-up. Prespecified adverse events occurred in 4.2% (1/24) of the intervention group and 8.0% (2/25) of the control group; no serious adverse events observed. Favorable functional outcome at 90 days occurred in 62.5% (14/24) in the intervention group versus 47.8% (11/23) in the control group; 30-day mortality was 8.3% (2/24) versus 13.0% (3/23), respectively. Conclusions ELP was feasible and demonstrated an acceptable safety profile in moderate anterior circulation AIS; observed trends in functional outcomes and survival provide preliminary indications of benefit, supporting further evaluation in a definitive randomized trial. Conflict of interest Bonifacio C. Pedregosa II, MD: nothing to disclose. Jose C. Navarro, MD, MSc: nothing to disclose.