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Acute ischemic stroke — USMLE Step 3 MCQ

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HardEmergency MedicineAcute ischemic strokeUSMLE Step 3

A 66-year-old man presents 10 hours after sudden coma, quadriparesis, and dysarthria. CT shows no hemorrhage, CT angiography shows proximal basilar-artery occlusion, NIH Stroke Scale score is 24, and imaging shows limited established infarction. He received no thrombolytic because onset time was uncertain. Which reperfusion strategy is most appropriate?

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Correct answer: B — Proceed urgently to endovascular thrombectomy evaluation within the extended window

The best answer is “Proceed urgently to endovascular thrombectomy evaluation within the extended window”. Modern randomized evidence supports thrombectomy for selected moderate-to-severe basilar occlusion within 24 hours when imaging does not show extensive irreversible injury. Uncertain onset or absence of prior thrombolysis does not preclude endovascular treatment.

Reference: Society of Vascular and Interventional Neurology Practice Update: Basilar Artery Occlusion: https://pubmed.ncbi.nlm.nih.gov/38670791/