Now 8hrs 20 mins (500 mins) since last seen well, BP currently 190/110, NIHSS unchanged at 21.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP shows penumbra >15ml, core <70ml, mismatch ratio greater than 1.8, favourable towards treatment.
Any BP intervention?
- No BP intervention
- Lower SBP to <180mmHg before bolus
- Start lowering BP, but give bolus before attaining target
All of our experienced colleagues recommended lowering BP before giving lysis.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
4/5 experienced colleagues recommended alteplase 0.9mg/kg and 1/5 recommended no lysis.
Refer for thrombectomy?
- Yes
- No
All of our experienced colleagues recommended referral for thrombectomy.
