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Acute Ischaemic Stroke – Large Vessel Occlusion — SCE Neurology MCQ

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HardCerebrovascular DiseaseAcute Ischaemic Stroke – Large Vessel OcclusionSCE Neurology

A 69-year-old arrives 110 minutes after onset of a disabling left MCA syndrome. CT excludes haemorrhage; CTA shows an M1 occlusion. Blood pressure is 174/96 mmHg and there are no thrombolysis exclusions. The thrombectomy team is mobilising. What should happen next?

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Correct answer: B — Give intravenous thrombolysis and continue directly to thrombectomy

An otherwise eligible patient within 4.5 hours should receive intravenous thrombolysis while thrombectomy proceeds; treatment should not be delayed to see whether the artery recanalises. Direct thrombectomy is used when thrombolysis is unsuitable, whereas heparin and aspirin are not substitutes for acute reperfusion in an eligible disabling large-vessel stroke.

Reference: NICE NG128 stroke and transient ischaemic attack: recommendations (Current NICE recommendations; reviewed March 2026): https://www.nice.org.uk/guidance/ng128/chapter/Recommendations