Now 3 hrs 20 mins (200 mins) since onset, BP currently 172/85, NIHSS improved from 13 to 9 – now speaking a little and less weak.
What would you do next?
Request further advanced imaging (e.g. CTP, MRI, MRP) to guide treatment?
CTP small cortical perfusion deficit, no corresponding CBF abnormality, therefore salvageable tissue present.
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 experienced colleagues recommended alteplase 0.9mg/kg and 2/5 recommended no lysis.
Refer for thrombectomy?
- Yes
- No
None of our experienced colleagues recommended referral for thrombectomy.