From the Guidelines
Vertebrobasilar artery syndrome should be diagnosed and treated with a thorough clinical history and examination followed by noninvasive imaging, and management should focus on addressing the underlying cause, often with antiplatelet therapy, risk factor modification, and consideration of interventional procedures for severe stenosis. The diagnosis of Vertebrobasilar (VBA) artery syndrome typically involves a combination of clinical presentation and imaging studies. Key symptoms include:
- Dizziness
- Vertigo
- Diplopia (double vision)
- Dysarthria (slurred speech)
- Ataxia (poor coordination)
- Visual field defects According to the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1, evaluation of a patient with presumed vertebrobasilar insufficiency should begin with a thorough clinical history and examination followed by noninvasive imaging. Treatment of VBA syndrome focuses on addressing the underlying cause, which is often atherosclerosis or arterial dissection, and may include:
- Antiplatelet therapy with aspirin 81-325mg daily or clopidogrel 75mg daily
- Risk factor modification such as blood pressure control (target <140/90 mmHg), cholesterol management with statins, smoking cessation, and diabetes control
- Consideration of interventional procedures like angioplasty with stenting for severe stenosis
- Urgent neuroimaging with CT or MRI and vascular imaging for acute presentations resembling stroke to rule out large vessel occlusion requiring thrombectomy
- Rehabilitation including physical and occupational therapy for recovery from neurological deficits.
From the Research
Diagnosis of Vertebrobasilar (VBA) Artery Syndrome
- The diagnosis of VBA artery syndrome can be challenging, as the symptoms may be non-specific, such as vertigo, and may not be immediately recognized as related to VBA insufficiency 2.
- Imaging studies, such as MRI and MRA, can be used to diagnose VBA artery stenosis, but may not always detect the severity of the stenosis 2.
- Invasive angiography may be necessary to confirm the diagnosis and assess the severity of the stenosis 2, 3, 4.
Treatment of Vertebrobasilar (VBA) Artery Syndrome
- The treatment of VBA artery syndrome depends on the severity of the stenosis and the presence of symptoms, and may include medical therapy, endovascular treatment, or surgery 5, 3, 4, 6.
- Endovascular treatment, such as balloon angioplasty and stenting, can be used to treat VBA artery stenosis, and may be combined with medical therapy to stabilize blood flow in the posterior circulation 5, 3, 4, 6.
- Surgical treatment, such as bypass surgery, may be necessary in some cases, particularly if the stenosis is severe or if endovascular treatment is not possible 5.
- The choice of treatment should be individualized based on the patient's specific condition and medical history, and should be made in consultation with a multidisciplinary team of healthcare professionals, including neurologists, cardiologists, and radiologists 2, 6.
Outcomes of Treatment
- The outcomes of treatment for VBA artery syndrome can vary depending on the severity of the stenosis and the presence of symptoms, but can be generally favorable with prompt and appropriate treatment 5, 3, 4, 6.
- Complications of treatment, such as stroke or death, can occur, particularly if the stenosis is severe or if the patient has underlying medical conditions 3, 4, 6.
- Long-term follow-up is necessary to monitor the patient's condition and adjust treatment as needed to prevent recurrent symptoms or complications 5, 6.