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Acute Ischaemic Stroke with LVO — RACP Adult Medicine MCQ

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ModerateNeurologyAcute Ischaemic Stroke with LVORACP Adult Medicine

A 55-year-old woman presents with left MCA syndrome (right hemiplegia, aphasia) with onset 5 hours ago. CT brain shows no haemorrhage. CT angiography confirms left M1 occlusion. CT perfusion shows a large penumbra. What is the most appropriate treatment?

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Correct answer: B — Mechanical thrombectomy alone

Large vessel occlusion (M1) with significant penumbra on perfusion imaging is an indication for mechanical thrombectomy. The time window extends to 24 hours if there is a mismatch between core infarct and penumbra (DAWN, DEFUSE 3 trials). Beyond 4.5 hours, IV alteplase alone is insufficient for LVO.

Reference: Stroke Foundation Australia – 2024 – Clinical Guidelines for Stroke Management