A 59-year-old man was last seen well 14 hours ago and now has aphasia and right hemiparesis. CT angiography shows a left middle cerebral artery occlusion with salvageable tissue on perfusion imaging. What does NICE advise?

Answer and explanation

Correct answer: A. Offer mechanical thrombectomy

  1. Step 1: Time since last known well is 14 hours, beyond the thrombolysis window.
  2. Step 2: NICE extended thrombectomy eligibility to 6 to 24 hours from last known well for confirmed occlusion with salvageable tissue.
Answer
Offer mechanical thrombectomy.
Why not the others: No thrombectomy, since it is never permitted beyond 6 hours in any circumstance: The 6-hour limit applies only when imaging selection is not used. Thrombolysis only, since thrombectomy is limited to posterior circulation strokes: Thrombolysis is outside its window, and thrombectomy is not limited to posterior vessels. Defer treatment until a repeat CT at 48 hours shows the final infarct size: Waiting 48 hours would allow the infarct to complete.

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