Question

A 64-year-old with a witnessed anterior circulation large vessel occlusion (confirmed CTA) presents 10 hours after last known well. Perfusion imaging shows small core and large penumbra. Best next step?

Accepted Answer

Mechanical thrombectomy because imaging selects a mismatch up to 24 hours

Answer

No reperfusion therapy due to >6-hour window

Answer

Alteplase IV because time <12 hours

Answer

Aspirin only and admit to stroke unit

Answer

Immediate carotid endarterectomy

Practice question

A 64-year-old with a witnessed anterior circulation large vessel occlusion (confirmed CTA) presents 10 hours after last known well. Perfusion imaging shows small core and large penumbra. Best next step?