A 58-year-old man presents with acute onset right hemiplegia, global aphasia, and gaze preference to the left. CT angiography shows a left M1 MCA occlusion. His NIHSS is 18. He is within 5 hours of symptom onset and has no hemorrhage on non-contrast CT. Which intervention is the standard of care in addition to IV alteplase?
- A Intra-arterial alteplase infusion
- B Hypothermia protocol
- C Mechanical thrombectomy ✓
- D Emergency carotid endarterectomy
Correct answer: C. Mechanical thrombectomy
Explanation
Mechanical thrombectomy is indicated for anterior circulation large vessel occlusion (ICA or M1 MCA) within 24 hours when eligibility criteria are met (DAWN/DEFUSE 3 trials). It is given alongside IV thrombolysis when the patient qualifies for both. IA thrombolysis is not standard. Carotid endarterectomy is for symptomatic stenosis in secondary prevention, not acute occlusion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.