From the Guidelines
Vertebral artery flow should be managed with antiplatelet therapy, such as aspirin 81-325mg daily or clopidogrel 75mg daily, in patients with atherosclerosis of the extracranial vertebral arteries, as recommended by the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline 1. The vertebral arteries are crucial blood vessels that supply blood to the brain, specifically the posterior portion including the brainstem, cerebellum, and occipital lobes. Normal vertebral artery flow is bidirectional and symmetric, with blood flowing upward through the neck to join and form the basilar artery. Some key points to consider in managing vertebral artery flow include:
- Disruptions in vertebral artery flow can occur due to atherosclerosis, dissection, compression from cervical spondylosis, or anatomical variations like vertebral artery hypoplasia.
- Symptoms of compromised flow may include dizziness, vertigo, visual disturbances, and ataxia.
- Diagnosis of vertebral artery flow issues typically involves ultrasound (including transcranial Doppler), CT angiography, MR angiography, or conventional angiography.
- Treatment depends on the underlying cause and may include antiplatelet therapy, anticoagulation (if dissection is present), surgical interventions for severe stenosis, or endovascular procedures like stenting, as noted in the 2011 guideline 1.
- Maintaining adequate blood pressure control and addressing modifiable cardiovascular risk factors are also important for preserving vertebral artery flow. In patients with symptomatic vertebral artery stenosis, medical management should follow the guidelines set forth for those with disease of the carotid arteries, including measures directed at reduction of systemic atherosclerotic risk and the prevention of ischemic complications in other vascular beds, as recommended by the 2011 guideline 1.
From the Research
Vertebral Artery Flow
- Vertebral artery stenosis is associated with a high risk of early recurrent stroke 2
- The vertebral artery supplies blood to the hindbrain, and reduced blood flow can cause signs and symptoms of vertebrobasilar ischaemia 3
- Factors that may cause a reduction in vertebral artery blood flow include:
- Exostoses, such as the retroarticular canal and lateral bridge of the atlas vertebra, which may cause compression of the related part of the vertebral artery 3
- Atherosclerosis of the artery wall, which may occlude the vessel lumen 3
- Functional factors, such as sustained end-of-range rotation of the cervical spine, which may cause distortion of the vertebral artery in the suboccipital region 3
- Vertebral artery dissections can be caused by minor mechanisms and may lead to significant arterial stenosis, occlusion, or pseudoaneurysm formation with subsequent hemodynamic and embolic infarcts 4, 5
- Treatment options for vertebral artery stenosis and dissection include:
- Angioplasty and stenting, which can provide good technical results 2
- Anticoagulation with intravenous heparin followed by oral warfarin, which may be recommended for all patients with acute dissections, unless there are contra-indications 4
- Protected stent-assisted angioplasty, which appears to be a safe and effective method of restoring vessel lumen integrity 4
- Best medical treatment (BMT) alone, which may be compared to vertebral angioplasty and stenting in terms of efficacy and safety 6