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A 51-year-old male presented with dysarthria and weakness on his left side. In his history, he had an operation due to aortic coarctation 13 years ago, and 5 years ago, he had a transient ischemic attack along with difficulty in speaking. During his neurological examination, he was conscious, cooperative, and oriented. Mild dysarthria and left hemiparesis were seen (4/5, 4/5). He smoked at least one cigarette packet per day for 30 years. Vascularization was performed only by narrowed right vertebral artery on cranial and cervical magnetic resonance angiography. He had a mild increase in his left hemiparesis during his stay in the hospital (2/5, 4/5). A stent had been inserted into his right vertebral artery during digital subtraction angiography. In his last neurological examination, he was conscious, cooperative, and oriented. We started prasugrel (10 mg/day) and acetylsalicylic acid (300 mg/day) for his mild dysarthria and mild hemiparesis. In this case, we explain that although there was three-vessel occlusion and narrowing in the right vertebral artery, the patient’s neurologic status was not too bad due to collateral circulation around the cerebral arteries. This showed us the importance of collateral circulation between cerebral arteries.