Abstract
RATIONALE: Vertebral artery dissection (VAD) is a frequently overlooked cause of posterior circulation stroke in young adults, and the safety of intravenous thrombolysis in this setting remains debated. We report a case of acute ischemic stroke secondary to V3-segment VAD that progressed despite dual antiplatelet therapy, responded promptly to recombinant tissue-plasminogen activator thrombolysis, and showed complete vascular healing at 3 months. The study aim is to underscore that VAD is not an absolute contraindication to thrombolysis and to highlight the value of early recognition and individualized thrombolytic therapy for improving outcomes in young patients with VAD-related stroke. PATIENT CONCERNS: The patient, a 30-year-old male, was admitted to the hospital at 11:45 on January 24, 2019, due to transient episodic weakness in the right limbs that occurred 2 hours ago, lasting for 30 minutes. DIAGNOSES: Left vertebral artery V3 dissection; bulbar lacunar infarction; grade 2 hypertension; polycystic kidney; polycystic liver; lung infection. INTERVENTIONS: The patient was diagnosed with a dissection of the V3 segment of the vertebral artery through cranial computed tomography angiography. The disease continued to progress despite dual antiplatelet aggregation therapy with aspirin and clopidogrel. Therefore, intravenous thrombolytic therapy was administered. OUTCOMES: On February 11, 2019, the patient was discharged after an improvement in symptoms. There were no neurological deficit symptoms observed at that time. The patient did not experience any subsequent acute ischemic stroke events. The patient showed no hemorrhagic transformation or serious complications. Three months later, the patient had returned to work. Follow-up imaging after 3 months showed complete repair of the vessel with vertebral artery dissection. LESSONS: The most common clinical manifestations of VAD include dizziness/vertigo, headache, neck pain, and secondary neurologic deficits. However, these symptoms are often nonspecific. This can lead to frequent misdiagnosis or missed diagnosis of the disease. The efficacy and safety of intravenous thrombolysis for ischemic stroke due to VAD remains controversial due to its potential risks. VAD is not considered a contraindication to intravenous thrombolysis.In some cases, VAD endometrial damage can be repaired on its own after regular medical treatment.