Question 143 · LEK · Ischemic stroke

A 72-year-old female patient was admitted to the hospital because of right-sided hemiparesis that occurred 3 hours earlier. The computer tomography was performed and showed no abnormalities. The ultrasound duplex imaging of the carotid, vertebral and intracranial arteries showed 90-95% stenosis of the left internal carotid artery and 50% stenosis of the right internal carotid artery. Indicate the correct management in that case:

1. AA. endarterectomy of the left internal carotid artery as quickly as possible, but not later than 6 hours after the occurrence of the stroke.
2. BB. immediate thrombolytic treatment in the absence of contraindications to the intravenous therapy with recombined plasminogen activator.
3. CC. because of no abnormalities on CT scan the therapy should be postponed for at least 12 hours and then the computed tomography should be repeated to obtain more precise diagnosis.
4. DD. because of the suspicion of ischemic stroke, immediately after the admission to the hospital (or even during prehospital period, if possible) low molecular weight heparin should be given subcutaneously in a single therapeutic dose, and then consider the indications for thrombolytic therapy.
5. EE. because the time since the stroke in which intravenous thrombolytic therapy can be performed elapsed the patient should not be qualified to such a therapy but instead 300 mg of acetylsalicylic acid should be administered and the patient should be qualified for endarterectomy of the right internal carotid artery within 6 weeks after the stroke as a secondary prophylaxis.