Emergency Medicine Journal Verified May 2026

James calculated: Door-to-needle time would be 82 minutes if they gave alteplase now. But giving thrombolysis before transfer to thrombectomy carries bleeding risk if the clot doesn’t move.

The stroke consultant, Dr. Khan, arrived. “This is a large vessel occlusion. Thrombolysis alone may not recanalise. We need mechanical thrombectomy, but our nearest centre is 45 minutes away by ambulance.” emergency medicine journal

Just then, the trauma patient was moved. The CT slot opened. CT head was performed at 67 minutes from onset: No haemorrhage. No early ischaemic changes on ASPECTS. CT angiography showed a proximal left middle cerebral artery (M1) occlusion with good collaterals. James calculated: Door-to-needle time would be 82 minutes

“Status epilepticus? Or stroke progression?” James murmured. He gave 2 mg IV lorazepam. The jerking stopped, but the aphasia and hemiparesis remained unchanged. Khan, arrived