A patient is found with disabling aphasia 14 hours after last known well. CT excludes hemorrhage; CTA shows an ICA–M1 occlusion and CT perfusion

Question

A patient is found with disabling aphasia 14 hours after last known well. CT excludes hemorrhage; CTA shows an ICA–M1 occlusion and CT perfusion shows a small core with a large mismatch. There is no contraindication to endovascular therapy. What is the next reperfusion strategy?

Accepted Answer

Proceed directly to EVT using favourable perfusion selection without delaying for IV thrombolysis

Answer

Defer reperfusion because the last-known-well time exceeds the standard IV-thrombolysis window

Answer

Offer tenecteplase before EVT because favourable mismatch permits late-window thrombolysis

Answer

Delay EVT until MRI confirms DWI-FLAIR mismatch despite the favourable CT-perfusion profile

Answer

Start dual antiplatelet therapy and repeat vascular imaging after six hours of observation

Convulsive status epilepticus — RCPSC EM MCQ

A patient is found with disabling aphasia 14 hours after last known well. CT excludes hemorrhage; CTA shows an ICA–M1 occlusion and CT perfusion shows a small core with a large mismatch. There is no contraindication to endovascular therapy. What is the next reperfusion strategy?