Ischemic stroke within 4.5 hours is a candidate for which therapy if no contraindications exist?

• A. Antiplatelet therapy only
• B. Mechanical thrombectomy only
• C. Intravenous thrombolysis with alteplase (tPA)
• D. Corticosteroids

Answer: (C)

The main idea here is rapid reperfusion in an ischemic stroke. When ischemic stroke symptoms start and the patient is within 4.5 hours and has no contraindications, giving intravenous thrombolysis with alteplase (tPA) is the treatment that best restores blood flow by dissolving the clot. This can meaningfully reduce disability by reestablishing perfusion to affected brain tissue and improves functional outcomes when administered promptly.

Antiplatelet therapy alone isn’t the preferred reperfusion strategy in this very early window because it doesn’t dissolve the clot quickly enough to prevent early damage, and if tPA is given, antiplatelets are typically held for a period afterward due to bleeding risk. Corticosteroids have no role in improving outcomes for acute ischemic stroke. Mechanical thrombectomy is very important for certain large vessel occlusions and has a broader window in some patients, but within the strict 4.5-hour window, intravenous tPA is the standard initial therapy for eligible individuals.