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Endovascular Thrombectomy — RACP Adult Medicine MCQ

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EasyNeurologyEndovascular ThrombectomyRACP Adult Medicine

A 70-year-old woman presents 3 hours after sudden onset left hemiparesis and neglect. CT shows no haemorrhage. CTA shows right MCA M1 occlusion (large vessel occlusion). NIHSS is 18. She has received IV alteplase. What is the most appropriate next step?

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Correct answer: E — Endovascular thrombectomy alone

Large vessel occlusion (MCA M1) with NIHSS ≥6 within 6 hours (or up to 24 hours with salvageable tissue on perfusion imaging) is an indication for endovascular thrombectomy (mechanical clot retrieval) IN ADDITION to IV alteplase (if eligible). Multiple RCTs (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME, REVASCAT) showed dramatic benefit. NNT = 2.6 for reduced disability. Thrombectomy alone is indicated if alteplase is contraindicated.

Reference: Stroke Foundation Australia – 2024; EXTEND-IA Trial