title: Diagnosis and management of vertebrobasilar insufficiency.
abstract: 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.
authors: 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.
authors: Aaron
authors: A
authors: Stayman
authors: Raul G
authors: RG
authors: Nogueira
authors: Rishi
authors: R
authors: Gupta
references: Stroke. 2009 Aug;40(8):2732-7
references: 19478210
references: Stroke. 2006 Oct;37(10):2562-6
references: 16960090
references: Bull New Engl Med Cent. 1953 Jun;15(2):53-60
references: 13051693
references: Stroke. 2009 Nov;40(11):3504-10
references: 19762709
references: Brain. 1946 Jun;69(2):73-121
references: 20274363
references: Eur Radiol. 2010 Feb;20(2):469-76
references: 19697041
references: N Engl J Med. 2011 Sep 15;365(11):993-1003
references: 21899409
references: Neurosurgery. 2003 May;52(5):1033-9; discussion 1039-40
references: 12699544
references: Laryngoscope. 2009 Oct;119(10):2071-6
references: 19688845
references: Stroke. 2009 Nov;40(11):3499-503
references: 19762707
references: Stroke. 1998 Jul;29(7):1389-92
references: 9660392
references: Neurology. 1993 Jan;43(1):216-8
references: 8423891
references: Stroke. 2006 Oct;37(10):2499-503
references: 16960096
references: Stroke. 2009 Dec;40(12):3745-51
references: 19797177
references: Stroke. 2011 Aug;42(8):2212-6
references: 21700936
references: Stroke. 2007 Sep;38(9):2605-11
references: 17656656
references: Brain. 1962 Dec;85:741-74
references: 14000840
references: Ann Neurol. 2004 Sep;56(3):389-98
references: 15349866
references: Neurology. 1960 Sep;10:855-8
references: 13711476
references: Int J Audiol. 2012 May;51(5):379-88
references: 22299665
references: Arch Neurol. 2012 Mar;69(3):346-51
references: 22083796
references: Stroke. 2012 Mar;43(3):747-52
references: 22343653
references: J Ultrasound Med. 1997 Mar;16(3):213-8
references: 9166821
references: J Neurointerv Surg. 2011 Mar;3(1):54-6
references: 21990790
references: Brain. 2009 Apr;132(Pt 4):982-8
references: 19293244
references: J Neuroimaging. 2008 Jul;18(3):336-9
references: 18321249
references: J Neurointerv Surg. 2011 Jun;3(2):100-30
references: 21990803
references: J Neurol Neurosurg Psychiatry. 2009 Dec;80(12):1390-3
references: 19917819
references: Neurology. 2008 Nov 25;71(22):1804-11
references: 19029520
references: Arch Neurol. 2005 Aug;62(8):1228-31
references: 16087763
references: Stroke. 1988 Sep;19(9):1083-92
references: 3413804
references: Arch Neurol. 1989 Mar;46(3):281-4
references: 2919982
references: Neurology. 2004 Jul 27;63(2):344
references: 15277632
references: Med Sci Monit. 2012 May;18(5):RA57-63
references: 22534720
references: Neurol Med Chir (Tokyo). 2004 Mar;44(3):105-10; discussion 110-1
references: 15095962
references: J Neurol Neurosurg Psychiatry. 2007 Nov;78(11):1218-25
references: 17287234
references: AJNR Am J Neuroradiol. 2005 May;26(5):1012-21
references: 15891154
references: J Cereb Blood Flow Metab. 2011 May;31(5):1293-301
references: 21157476
references: Curr Treat Options Cardiovasc Med. 2004 Jun;6(3):179-192
references: 15096309
references: Stroke. 1985 Jul-Aug;16(4):626-9
references: 4024175
references: Proc Staff Meet Mayo Clin. 1955 Feb 23;30(4):61-8
references: 14357427
references: Stroke. 1994 Oct;25(10):1931-4
references: 7916499
references: Stroke. 2005 Jun;36(6):1140-5
references: 15890993