Extracranial Vertebral Artery Dissecting Aneurysm Presenting as Vertebrobasilar Stroke in a Young Adult: Case Report of Flow-Diverter Stenting

Background: Extracranial vertebral artery aneurysms (EVAAs) are exceptionally rare vascular lesions and an uncommon cause of posterior circulation stroke. Their diagnosis is often delayed due to nonspecific symptoms, yet prompt recognition is essential to guide management. Objective: This study aimed to report a rare case of an extracranial vertebral artery dissecting aneurysm presenting as a posterior circulation stroke in a young adult, successfully managed with flow-diverter stenting. Clinical Case: A 33-year-old woman presented with sudden-onset dysarthria, vertigo, nausea, and vomiting. Brain magnetic resonance imaging revealed infarcts in the left occipital lobe, cerebellar peduncle, and both cerebellar hemispheres. Computed tomography angiography (CTA) demonstrated a fusiform aneurysm in the V2 segment of the left vertebral artery, and digital subtraction angiography (DSA) confirmed a dissecting aneurysm. The patient was successfully treated with a flow-diverting stent and remained stable at 6 months’ follow-up with mRS 1. Results: EVAA are uncommon but can manifest as posterior circulation ischemic events in young patients. Endovascular treatment with flow-diverting stents has been reported as a feasible option in selected cases, although evidence remains limited to case reports and small series. Conclusions: This case underscores the importance of considering rare yet potentially treatable etiologies of vertebrobasilar stroke in young patients and highlights the value of a multidisciplinary approach to management.