Which of the following is part of the acute management of ischemic stroke within 4 hours?

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The main idea here is rapid reperfusion of an ischemic stroke within a tight time window. Intravenous thrombolysis with alteplase dissolves the clot and can improve functional outcome if given within about four hours of onset in patients who have no contraindications and whose brain imaging rules out hemorrhage. This is why it fits the acute management within four hours so well—the therapy directly addresses the occlusion causing the stroke and can salvage brain tissue when delivered promptly after onset.

Anticoagulation with warfarin is not used in the hyperacute phase because it takes time to become therapeutic and increases bleeding risk, making it unsuitable as an immediate treatment for the acute event. Mechanical ventilation by itself does not treat the clot causing the stroke, and carotid endarterectomy targets carotid plaque and is not an immediate reperfusion therapy within the four-hour window.