Thrombolytic therapy in vertebrobasilar dolichoectasia patients with acute posterior circulation cerebral infarction: a case series analysis

Vertebrobasilar dolichoectasia (VBD) is a rare cerebrovascular condition marked by elongation and dilation of the vertebral and basilar arteries. Patients with VBD often have strokes in the posterior circulation, but the safety and efficacy of intravenous thrombolysis (IVT) in this population are not well established. We report two cases of acute posterior circulation infarction in VBD patients who received IVT with tenecteplase. Patient 1 was a 56-year-old man. He received IV tenecteplase (0.25 mg/kg) one hour after arrival, and his deficits resolved (NIHSS 0) by the end of infusion with no hemorrhagic complications. He remained stroke-free at 1 year on dual antiplatelet therapy and statin.Patient 2 was a 39-year-old man. He received IV tenecteplase 78 min after arrival and similarly recovered to NIHSS 0 with no bleeding. He was asymptomatic at 3 months but had a recurrent cerebellar stroke at 6 months due to poorly controlled hypertension and hyperlipidemia. These cases suggest that IVT can be effective in VBD-related stroke, but emphasize the importance of aggressive risk factor management.