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Diagnosis and Management of Vertebrobasilar Insufficiency

  • Vascular Disease (H Gornik and E Kim, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Understanding the anatomical pathways and clinical presentations for VBI are of the utmost importance due to the potential mimics that may occur. After identification of the entity, imaging must be performed to identify the etiology. Distinguishing external compression of the vertebral artery from intrinsic vascular disease due to atherosclerosis or dissection is critical to aid the clinician in the therapeutic decision tree. Patients with an external compression due to an osteophyte may benefit from definitive surgical decompression and excision of the bony structure. Patients with extracranial disease of the vertebral artery who have failed maximal medical therapy may benefit from angioplasty and stenting which appears to carry a low morbidity. Extracranial vertebral artery dissections can be treated with medical therapy using anti-platelet agents or on occasion anti-coagulation. Rarely, endovascular options are required if a patient is having hemodynamic stroke or TIAs due to flow failure. In such circumstances, stenting and angioplasty may be considered. Intracranial atherosclerosis is best managed with maximal medical therapy due to the high rate of complications attributable to stenting and angioplasty.

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Disclosure

Dr. Aaron Stayman reported no conflicts of interest relevant to this article. Dr. Raul Nogueira received consultancies from Stryker Neurovascular, Covidien, Penumbra, Inc, Coaxia, and Rapid Medical. Dr. Rishi Gupta is the Associate Editor Journal of Neuroimaging. Dr. Gupta received consultancies from Stryker Neurovascular and Covidien.

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  1. Emory University School of Medicine, Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, 49 Jesse Hill Jr. Drive, SE, Faculty Office Bldg. #393, Atlanta, GA, 30303, USA

    Aaron Stayman MD, Raul G Nogueira MD & Rishi Gupta MD

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  1. Aaron Stayman MD
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Correspondence to Rishi Gupta MD.

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Stayman, A., Nogueira, R.G. & Gupta, R. Diagnosis and Management of Vertebrobasilar Insufficiency. Curr Treat Options Cardio Med 15, 240–251 (2013). https://doi.org/10.1007/s11936-013-0228-7

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