Megadolichobasilar ectasia is defined as marked elongation, widening, and tortuosity of the basilar artery.1 Intracranial dolichoectasia is associated with an increased risk of ischemic and hemorrhagic stroke and is found in 10% to 12% of patients with stroke.2 Intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) is the only approved therapy for acute ischemic stroke3 but is contraindicated in patients with increased risk of intracranial hemorrhage. Data on the bleeding risk in patients with megadolichobasilar ectasia treated with IV rtPA are nonexistent.