A 72-year-old man presents with sudden left-sided hemiplegia and hemianopia 3.5 hours after symptom onset. NIHSS score is 18. CT head shows no hemorrhage and no established infarct core. Which intervention provides the greatest additional benefit over IV thrombolysis alone in this patient with proximal M1 occlusion?

• A IV tenecteplase instead of alteplase
• B Mechanical thrombectomy (endovascular treatment) ✓
• C Dual antiplatelet therapy (aspirin + clopidogrel)
• D Heparin anticoagulation to prevent re-occlusion

Explanation

Mechanical thrombectomy is the standard of care for large vessel occlusion (LVO) ischemic stroke within 6 hours (and up to 24 hours in selected patients per DAWN/DEFUSE-3 criteria). Multiple RCTs (MR CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, THRACE) showed NNT of 2.6 for functional independence. Thrombectomy is superior to IV thrombolysis alone for M1/ICA occlusions. Dual antiplatelet and heparin are not acute reperfusion strategies.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.