Now 3 hrs 40 mins (220 mins) since onset, BP currently 150/76, NIHSS unchanged at 10.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP not technically adequate, patient moved. The perfusion deficits, ant and post fossa, bilateral, most of which can’t be real.
No CBF abnormality, may be accurate, reflecting no established core. This is supported by normal CT brain.
Any BP intervention?
- No BP intervention
- Lower SBP to <180mmHg before bolus
- Start lowering BP, but give bolus before attaining target
None of our experienced colleagues recommended BP intervention.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
None of our experienced colleagues recommended lysis.
Refer for thrombectomy?
- Yes
- No
4/5 of our experienced colleagues recommended referral for thrombectomy, 1/5 did not.
