Now 4 hrs 25 mins (265 mins) since onset, BP currently 170/74, NIHSS unchanged at 12.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP favourable towards treatment, shows penumbra >15ml, core <70ml, mismatch ratio greater than 1.8, however no LVO therefore not for thrombectomy.
Any BP intervention?
- No BP intervention
- Lower SBP to <180mmHg before bolus
- Start lowering BP, but give bolus before attaining target
None of our experienced colleagues recommended BP intervention.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
3/5 recommended alteplase 0.9mg/kg, 2/5 recommended no lysis.
Refer for thrombectomy?
- Yes
- No
None of our experienced colleagues recommended referral for thrombectomy.
