A 55-year-old man with hypertension and a 30 pack-year smoking history presents to the emergency department with acute-onset right hemiparesis and expressive aphasia. His wife reports symptom onset 4 hours prior to arrival. Vital signs: BP 158/92 mmHg, HR 98 bpm, RR 18, Temperature 37.2°C, SpO2 98% on room air. Physical examination confirms right-sided weakness (3/5) with non-fluent speech output. CT head is unremarkable for hemorrhage. CT angiography demonstrates occlusion of the left middle cerebral artery M1 segment. Laboratory studies show INR 1.0, glucose 128 mg/dL, and platelet count 245,000/μL. The patient has no history of anticoagulation use and no contraindications to intervention. Which of the following is the most appropriate next step in management?

1. A)Initiate intravenous heparin and serial neurological assessments
2. B)Administer intravenous alteplase followed by observation
3. C)Perform mechanical thrombectomyGABARITO
4. D)Administer aspirin 325 mg orally and discharge with outpatient neurology follow-up
5. E)Administer intravenous nitroglycerin to reduce blood pressure to <140/90 mmHg