Vertebrobasilar Insufficiency
Definition and Anatomy
- The American Heart Association notes that vertebrobasilar insufficiency involves compromised blood flow in the posterior circulation of the brain, specifically in the vertebral and basilar arteries 1, 3
- The vertebral arteries typically arise from the subclavian arteries, with the first three segments being extracranial 3, 4
- These arteries supply blood to the brainstem, cerebellum, and posterior portions of the brain 1, 5
Epidemiology
- The American College of Cardiology states that vertebral artery atherosclerosis may be the causative basis for approximately 20% of posterior circulation strokes 1, 2
- Annual stroke rates for patients with symptomatic intracranial vertebral and basilar artery stenosis are 8% and 11%, respectively 1, 5
Pathophysiology
- The American Heart Association reports that the most common cause of VBI is atherosclerotic stenosis affecting the first portion of the vertebral arteries or extending from plaques that compromise the origin of the vertebral arteries 1, 5
Clinical Presentation
- Common symptoms associated with vertebrobasilar insufficiency include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, and imbalance 1, 3, 5
Diagnosis
- The American College of Cardiology recommends that evaluation should begin with a thorough clinical history and examination followed by noninvasive imaging, including Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) 1, 7
Management
- The American Heart Association suggests that medical management follows guidelines similar to those for carotid artery disease, with antiplatelet therapy recommended as first-line treatment 3, 6
- Aspirin plus dipyridamole has shown benefit in reducing recurrent vertebrobasilar territory strokes compared to placebo (5.7% vs 10.8%) 3, 6