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Acute ischaemic stroke with large-vessel occlusion — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsAcute ischaemic stroke with large-vessel occlusionSCE Acute Medicine

A 72-year-old man presents 95 minutes after sudden right-sided weakness and aphasia. CT head shows no haemorrhage and CT angiography shows a left M1 occlusion. NIHSS is 18, BP is 178/94 mmHg and he was independent before this event. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous thrombolysis and refer urgently for mechanical thrombectomy

He is within the thrombolysis window and has a proximal large-vessel occlusion suitable for thrombectomy referral. Aspirin is delayed until haemorrhage has been excluded after thrombolysis timing considerations, and it is not definitive therapy for large-vessel occlusion. MRI should not delay reperfusion when CT/CTA is sufficient. The key is parallel decision-making: thrombolysis where eligible and thrombectomy pathway activation.

Reference: NICE NG128, Royal College of Physicians stroke guideline