TEN Neurologia Practice Questions - TEN - Título De Especialista Em Neurologia (Academia Brasileira De Neurologia AMB) Exam

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A 68-year-old woman was last seen well at 10:00 PM when going to bed. At 7:00 AM the next morning (9 hours later), her family finds her with dense left-sided hemiplegia and neglect (NIHSS score of 17). Non-contrast cranial CT reveals no intracranial hemorrhage and an ASPECTS score of 8. CT angiography confirms an occlusion of the M1 segment of the right middle cerebral artery. Perfusion CT demonstrates an ischemic core volume of 18 mL and a total hypoperfused penumbral volume of 94 mL (mismatch volume of 76 mL; mismatch ratio > 5.0). Based on the DAWN and DEFUSE-3 clinical trial criteria, what is the indicated management?

Immediate mechanical thrombectomy with a stent retriever and/or contact aspiration. Intravenous thrombolysis with alteplase 0.9 mg/kg followed by conservative observation. Immediate administration of dual antiplatelet therapy with aspirin and clopidogrel with blood pressure lowering. Observation in the stroke unit without endovascular intervention because symptom onset exceeded the 6-hour window.

Correct Answer:

Immediate mechanical thrombectomy with a stent retriever and/or contact aspiration.

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