Now 1 hr 20 mins (80 mins) since onset, BP currently 140/85, NIHSS worsened from 15 to 18.
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 GP intervention.
Any lysis intervention?
- No lysis
- Treat with alteplase 0.9mg/kg
- Treat with alteplase 0.6mg/kg
- Treat with tenecteplase
3/5 of our experienced colleagues recommended no lysis, 2/5 recommended alteplase 0.9mg/kg.
Refer for thrombectomy?
- Yes
- No
4/5 of our experienced colleagues recommended no referral for thrombectomy, 1/5 recommended referral.
