Intravenous thrombolysis in patient with vertebrobasilar dolichoectasia and antiplatelet medication

Abstract

Introduction: While the overall incidence of vertebrobasilar dolichoectasia (VBD) is less than 0.05%-0.06%, it is not uncommon in patients experiencing acute stroke. The influence of VBD on the outcome of intravenous (IV) thrombolysis therapy has not been widely studied. We present the following case of IV thrombolysis use in a patient experiencing acute stroke, who had an increased risk of bleeding due to prior antiplatelet use, and who had concomitant VBD. Case presentation: A 62-year-old man presented with weakness in the left extremities that had begun 1 hour prior to admission. The patient had a history of coronary artery disease and had been regularly taking antiplatelet medication. Upon arrival, the patient was in a decreased level of consciousness, with severe dysarthria, left central facial palsy, left lateralization, and a National Institute of Health Stroke Scale (NIHSS) score of 17. Computed tomography scan of the head showed no intracranial hemorrhage. The patient was administered IV thrombolysis at 2 hours and 45 minutes after symptom onset. Within the first 24 hours, the patient's NIHSS score decreased from 17 to 12, and the final NIHSS score prior to discharge was 7. The Head and neck angiography of this patient revealed VBD. Conclusion: This case demonstrated that IV thrombolysis is safe and effective for use in patients with acute ischemic stroke who have a history of antiplatelet usage and who experience concomitant VBD.

Keywords: Antiplatelet; Case report; Intravenous thrombolysis; Stroke; Vertebrobasilar dolichoectasia.

Fig. 1

CT scan showed a blurred insular ribbon on the right side (red arrow). The ventral calcification of the pons is shown (orange arrow). (Color version of figure are available online)

Fig. 2

CT Angiography showed arterial patency with stenosis of the right M1-M2 segment (red arrow). (Color version of figure are available online.)

Fig. 3

(A and B) Diffusion-weighted imaging (DWI) show an acute right frontal stroke. (C) DWI and (D) T2 show arterial compression on the pons (red arrow). (Color version of figure is available online.)

Fig. 4

A large vertebrobasilar artery (red arrow) is seen on CT angiography with the same size as the internal carotid artery (yellow arrow). (Color version of figure is available online.)