Now 5hrs 20 mins (320 mins) since entirely normal, BP currently 180/90, NIHSS still 1 at the moment.
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
3/4 of our experienced colleagues recommended no BP intevention, 1/4 recommended lowering before lysis.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
2/4 of our experienced colleagues recommended no lysis, 1/4 recommended alteplase 0.9mg/kg and 1/4 recommended tenectplase.
Refer for thrombectomy?
- Yes
- No
3/4 of our experienced colleagues recommended no referral for thrombectomy, and 1/4 recommended referral.
