Management of Congenital Hypoplasia of the Right Vertebral Artery
Clinical Presentation and Diagnosis
- Common symptoms associated with vertebral artery disease include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope, as reported by the Journal of Neurointerventional Surgery 1, 2
- Initial evaluation should include thorough clinical assessment followed by non-invasive imaging, according to the Journal of Neurointerventional Surgery and the Journal of the American College of Cardiology 1, 4, 5
Medical Management
- The American College of Cardiology recommends medical management following guidelines for carotid artery disease, as there are no randomized trials specifically evaluating treatment for vertebral artery anomalies 1, 5, 6
- Antiplatelet therapy is recommended as first-line treatment for symptomatic patients with evidence of ischemia, with combination therapy with aspirin plus dipyridamole showing benefit in reducing recurrent vertebrobasilar territory strokes compared to placebo (5.7% vs 10.8%), as reported by the Journal of Neurointerventional Surgery and the Journal of the American College of Cardiology 2, 5, 6, 7
- Ticlopidine has demonstrated superiority to aspirin for secondary prevention of ischemic events in patients with symptomatic posterior circulation disease, according to the Journal of Neurointerventional Surgery and the Journal of the American College of Cardiology 2, 6
Revascularization Considerations
- Surgical interventions are rarely performed for vertebral artery anomalies, and no randomized trials have addressed operative procedures for posterior cerebral circulation disease, as reported by the Journal of Neurointerventional Surgery and the Journal of the American College of Cardiology 1, 8
- Endovascular management has not been proven superior to best medical management in randomized trials, according to the Journal of Neurointerventional Surgery 1, 2
- In a review of 300 interventions for proximal vertebral artery stenosis, risks included death (0.3%), periprocedural neurological complications (5.5%), and posterior stroke (0.7%) at mean follow-up of 14.2 months, as reported by the Journal of Neurointerventional Surgery 2, 4