From the Guidelines
Asymptomatic vertebral artery flow abnormalities do not require specific treatment, and revascularization is not indicated, irrespective of the degree of severity. The management of asymptomatic vertebral artery stenosis is primarily focused on optimizing cardiovascular risk factors, including blood pressure control, statin therapy, smoking cessation, diabetes management, and lifestyle modifications such as regular exercise and a heart-healthy diet 1.
Key Considerations
- No medications are typically prescribed solely for asymptomatic vertebral artery flow variations, but low-dose aspirin (81 mg daily) may be considered in patients with multiple vascular risk factors, though this should be individualized.
- Regular follow-up with vascular imaging every 1-2 years is reasonable to monitor for progression.
- The vertebral-basilar system has good compensatory mechanisms, and collateral circulation often develops to maintain adequate posterior circulation blood flow.
Rationale
The rationale for this conservative approach is that vertebral artery flow variations are common anatomical findings, and many people have asymmetric flow between vertebral arteries without ever developing symptoms. Intervention is generally reserved for patients who develop symptoms such as dizziness, vertigo, visual disturbances, or other signs of vertebrobasilar insufficiency.
Additional Guidance
While guidelines for the management of symptomatic vertebral artery stenosis are less established, medical management typically follows 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 1.
From the Research
Asymptomatic Vertebral Artery Flow
- Asymptomatic vertebral artery stenosis can be treated with angioplasty and stenting, with good technical results 2
- The treatment of asymptomatic vertebral artery stenosis is still a topic of debate, with some studies suggesting that it may be beneficial in patients with severe lesions of anterior circulation 2
- Factors that may cause a reduction in vertebral artery blood flow include exostoses, atherosclerosis, and functional factors such as sustained end-of-range rotation of the cervical spine 3
- Asymptomatic restenosis was observed in one out of 19 patients who underwent follow-up angiography after angioplasty and stenting 2
- There is limited research on the specific topic of asymptomatic vertebral artery flow, with most studies focusing on symptomatic vertebral artery stenosis 4, 5
Treatment Options
- Angioplasty and stenting appear to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis 2
- Medical therapy alone may not be sufficient to prevent recurrent stroke in patients with vertebral artery stenosis, with an annual stroke rate of 10 to 15% 5
- Surgical revascularization is an alternative approach for the treatment of symptomatic vertebral artery stenosis, but carries a 10-20% mortality rate 5