Ischemic stroke treatment

A 65 year old man presents to the emergency department with acute onset right facial droop, right arm weakness, and aphasia. He was last known well 2 hours ago. What is the first step in management?

1: Immediate administration of IV recombinant tissue plasminogen activator (r-TPA)
2: Stat head CT without contrast
3: MRI brain without contrast
4: Mechanical thrombectomy