A 68-year-old man with a 10-year history of hypertension presents to the emergency department 5 hours after the acute onset of right facial droop, right arm weakness, and dysarthria. His wife reports he was fine when she left for work and found him unable to speak clearly upon her return. On examination, he is alert but drowsy, with right-sided hemiparesis (2/5 strength), facial asymmetry, and expressive aphasia. Vital signs: BP 172/98 mmHg, HR 104/min, RR 24/min, SpO2 97% on room air. Temperature is 37.2°C. Point-of-care glucose is 128 mg/dL. Non-contrast head CT performed emergently shows a hypodense left middle cerebral artery territory with subtle hypodensity in the left lentiform nucleus and evidence of mild cerebral edema with 3-mm midline shift. MRI obtained shortly after confirms acute ischemic stroke in the left MCA distribution. The patient is not a candidate for IV thrombolytic therapy due to time window considerations. Which of the following is the most appropriate next intervention?

1. A)Initiate dual antiplatelet therapy (aspirin and clopidogrel) and admit to ICU for close neurological monitoring
2. B)Proceed with urgent mechanical thrombectomy following vascular imaging
3. C)Administer high-dose IV mannitol and elevate head of bed 30 degrees to manage cerebral edema
4. D)Perform urgent decompressive hemicraniectomy with concurrent ICU admission for intensive managementGABARITO
5. E)Start IV heparin anticoagulation and supportive care in the stroke unit