Vascular: Vertebrobasilar Artery Disease

Vertebrobasilar Artery Disease

Basics

  • Posterior Circulation Ischemia from Basilar or Vertebral Artery Disease
  • Typicaly Requires Bilateral Vertebral Artery or Basilar Disease to See Changes
    • A Single Normal Vertebral Artery is Usually Sufficient for Perfusion

Causes

  • Atherosclerosis – Most Common
    • Most Common in Segment V1
  • Dissection
  • Aneurysm
  • Trauma
  • Extrinsic Compression by Bone/Tendon
    • Most Common in Segment V2

Presentation

  • Dizziness
  • Diplopia
  • Vertigo
  • Tinnitus
  • Ataxia
  • Drop Attacks

Diagnosis

  • Typical Imaging: CTA/MRA
  • Gold Standard: Arteriography

Treatment

  • Indications for Intervention:
    • ≥ 60% Stenosis in Bilateral Vertebral Arteries
    • ≥ 60% Stenosis in Dominant Artery with Contralateral Hypoplasia or Occlusion
  • General Interventions: Surgical Revascularization or Endovascular Stenting
  • Revascularization Procedures:
    • Proximal:
      • Transposition into the Common Carotid Artery (Most Common)
      • Saphenous Vein Bypass from Common Carotid or Subclavian Arteries
      • Vertebral Artery Endarterectomy
    • Distal:
      • Saphenous Vein Bypass (Most Common)
      • Transposition into the Internal Carotid Artery

Vertebrobasilar Artery System 1

References

  1. Bentsen L, Nygård A, Ovesen C, Christensen A, Rosenbaum S, Havsteen I, Christensen H. Vascular pathology in the extracranial vertebral arteries in patients with acute ischemic stroke. Cerebrovasc Dis Extra. 2014 Jan 31;4(1):19-27. (License: CC BY-NC-3.0)