Question

A 62-year-old with acute ischemic stroke (onset 90 minutes ago) has BP 208/118 mm Hg and is otherwise tPA-eligible. Best next step?

Accepted Answer

Lower BP to <185/110 mm Hg with IV labetalol before alteplase

Answer

Give IV alteplase immediately without treating blood pressure

Answer

Lower BP to <160/90 mm Hg before alteplase

Answer

Defer alteplase and give aspirin 325 mg now

Answer

Proceed to mechanical thrombectomy without imaging

Practice question

A 62-year-old with acute ischemic stroke (onset 90 minutes ago) has BP 208/118 mm Hg and is otherwise tPA-eligible. Best next step?