Now 2 hrs 55 mins (175 mins) since onset, BP currently 200/80, NIHSS unchanged at 20.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP shows perfusion deficit right side which when correlated with CT brain is old. CTP also shows a left sided perfusion deficit with no corresponding abnormality on CT brain and no CBF abnormality. Total numerical values are therefore an overestimate as they include the old infarct too, however the left sided deficit has not associated CBF abnormality therefore represents salvageable brain.
Any BP intervention?
- No BP intervention
- Lower SBP to <180mmHg before bolus
- Start lowering BP, but give bolus before attaining target
4/5 recommended lowering BP before lysis, one recommended no 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, 1/5 recommended tenecteplase and 1/5 recommended no lysis.
Refer for thrombectomy?
- Yes
- No
3/5 of our experienced colleagues recommended no referral for thrombectomy, 2/5 recommended referral.
