A 58-year-old woman with a 10-year history of hypertension presents to the emergency department with acute-onset right-sided hemiparesis and expressive aphasia. Symptoms began 4 hours ago while she was at home. Vital signs: BP 168/94 mmHg, HR 88/min, RR 16/min, temp 37.2°C, SpO2 98% on room air. Non-contrast CT head is unremarkable with no evidence of hemorrhage or acute ischemic changes. Labs show INR 0.98, platelet count 245,000/μL, and glucose 98 mg/dL. Carotid duplex ultrasound demonstrates severe left internal carotid artery (ICA) stenosis (>70%) with irregular, ulcerated plaque. The patient is not on anticoagulation therapy. Which of the following is the most appropriate next step in management?

1. A)Administer intravenous alteplase and proceed to urgent carotid endarterectomy within 24 hoursGABARITO
2. B)Initiate aspirin therapy and defer carotid intervention pending repeat imaging in 4 weeks
3. C)Start unfractionated heparin anticoagulation and schedule carotid endarterectomy within 2 weeks
4. D)Perform urgent carotid angiography followed by endovascular stent placement
5. E)Administer intravenous alteplase alone without carotid intervention at this time