From the Guidelines
Symptoms of vertebral artery stenosis include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope, as reported in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1. These symptoms occur due to compromised vertebrobasilar perfusion, which can be caused by atherosclerotic stenosis affecting the first portion of the vertebral arteries or extending from plaques that compromise the origin of the vertebral arteries 1. Some key symptoms to look out for include:
- Dizziness and vertigo, particularly when turning the head or looking upward
- Visual disturbances such as blurred vision, double vision, or temporary vision loss
- Headaches, especially in the back of the head
- Difficulty swallowing, slurred speech, or weakness and numbness on one side of the body
- Drop attacks (sudden falls without loss of consciousness) or transient ischemic attacks with temporary neurological deficits It is essential to seek immediate medical attention if these symptoms occur repeatedly, as vertebral artery stenosis can lead to stroke if left untreated 1.
From the Research
Symptoms of Vertebral Artery Stenosis
- Isolated positional vertigo or dizziness can be the initial presentation symptom of vertebral artery stenosis 2
- Transient ischemic attack of the semicircular canals or vestibular nucleus during rotation and extension of the neck, which compresses a contralateral stenotic VA in patients with bilateral VA abnormalities, can cause symptoms 2
- Acute vertigo, dizziness, and visual disturbances, along with ipsilateral sixth cranial nerve palsy, can be symptoms of distal vertebral artery stenosis 3
- Vertebral artery stenosis can cause high risk of early recurrent stroke, and symptoms can include stroke, death, or transient ischaemic attack (TIA) 4, 5, 6
Diagnosis and Treatment
- Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results 5
- Endovascular treatment (ET) consists of percutaneous transluminal angioplasty, with or without stenting, and can be combined with medical treatment (MT) to treat symptomatic vertebral artery stenosis 4
- A multimodal approach (IVT, MT, and stenting) can be effective in treating distal vertebral artery occlusion (Mori Type C) 3
- Vertebral angioplasty and stenting plus best medical treatment (BMT) can be compared to BMT alone for recently symptomatic VA stenosis, and results suggest that stenting could be associated with a reduced recurrent stroke risk in symptomatic VA 6