Neurology: extended-window stroke thrombectomy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: extended-window stroke thrombectomy

Sample item

A 64-year-old man developed witnessed left hemiparesis and gaze deviation 12 hours ago (NIHSS 16). CT shows a small infarct core, CT angiography shows right M1 occlusion and perfusion imaging shows a large salvageable penumbra. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Mechanical thrombectomy

Mechanical thrombectomy benefits selected patients with large-vessel occlusion up to 24 hours from onset when imaging shows a small core with substantial salvageable tissue (DAWN and DEFUSE-3 trials). Thrombolysis has a much shorter window and is not appropriate at 12 hours from witnessed onset. Craniectomy is for malignant oedema.

Option by option

  • A. Intravenous alteplase alone

    Alteplase is used within 4.5 hours, and extended imaging-based windows do not extend to 12 hours from witnessed onset.

  • B. Mechanical thrombectomy (correct)

    Correct. Imaging-selected patients with large-vessel occlusion may undergo thrombectomy up to 24 hours.

  • C. Antiplatelet therapy alone because all reperfusion options are time-expired

    Antiplatelet therapy alone gives up an effective reperfusion option for a salvageable penumbra.

  • D. Decompressive craniectomy

    Craniectomy treats established malignant oedema and does not restore blood flow.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Mechanical thrombectomy. Mechanical thrombectomy benefits selected patients with large-vessel occlusion up to 24 hours from onset when imaging shows a small core with substantial salvageable tissue (DAWN and DEFUSE-3 trials).

Why is "Intravenous alteplase alone" not the answer?

Alteplase is used within 4.5 hours, and extended imaging-based windows do not extend to 12 hours from witnessed onset.

Why is "Antiplatelet therapy alone because all reperfusion options are time-e…" not the answer?

Antiplatelet therapy alone gives up an effective reperfusion option for a salvageable penumbra.

Why is "Decompressive craniectomy" not the answer?

Craniectomy treats established malignant oedema and does not restore blood flow.

What concept does this question test?

It tests Neurology: extended-window stroke thrombectomy in General Medicine. Thrombolysis has a much shorter window and is not appropriate at 12 hours from witnessed onset. Craniectomy is for malignant oedema.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: extended-window stroke thrombectomy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.