Stroke Training and Awareness Resources (STARs)


08: Update and decisions

Now 1 hr 45 mins (105 mins) since onset, BP currently 142/83, NIHSS unchanged at 13.

What would you do next?

Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?

CTP shows penumbra >15ml, core <70ml, mismatch ratio greater than 1.8. favourable towards treatment.​

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

3/5 recommended no lysis, 1/5 recommended alteplase 0.9mg/kg and 1/5 recommended tenecteplase.

Refer for thrombectomy?

  • Yes
  • No

4/5 of our experienced colleagues recommended no referral for thrombectomy, 1/5 recommended referral.