Now 4 hours 40 mins (280 mins) since diplopia, BP currently 190/100, NIHSS unchanged at 13.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP shows perfusion deficit post fossa.
Any BP intervention?
- No BP intervention
- Lower SBP to <180mmHg before bolus
- Start lowering BP, but give bolus before attaining target
3/5 recommended no BP intervention, 2/5 recommended lowering BP before lysis.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
3/5 of our experienced colleagues recommended no lysis, 2/5 recommended alteplase 0.9mg/kg.
Refer for thrombectomy?
- Yes
- No
3/5 of our experienced colleagues recommended referral for thrombectomy, 2/5 recommended no referral.
