Abstract
BACKGROUND: Stroke is relatively uncommon in children, with a risk of recurrence ranging from 5% to 19%. Early diagnosis and treatment are critical for optimal recovery, but stroke in children is often identified later than in adults. While mechanical thrombectomy is a well-established standard treatment for acute ischemic strokes in adults, emerging data continue to show that this intervention can also benefit pediatric patients. OBSERVATIONS: This case report discusses the management of a 13-year-old male with recurrent basilar artery occlusions and an associated vertebral artery dissection. Initially presenting with acute ischemic stroke symptoms, the patient underwent a successful thrombectomy with significant improvement in neurological function. He experienced a second stroke due to another basilar artery occlusion, which was subsequently treated by a thrombectomy. Further investigation revealed a vertebral artery dissection with a pseudoaneurysm, likely contributing to the stroke recurrence. Treatment adjustments included transitioning from aspirin to clopidogrel when aspirin resistance concern was noted, and finally apixaban therapy when the dissection was discovered. The patient remained stable without stroke recurrence. LESSONS: This case exemplifies the effectiveness of mechanical thrombectomy in pediatric stroke management and warrants further consideration for repeat procedures for recurrence due to insidious vertebral arterial dissections and those with aspirin resistance. https://thejns.org/doi/10.3171/CASE24523.