Diagnosis and Management of Vertebrobasilar Insufficiency

Abstract

Understanding the anatomical pathways and clinical presentations for VBI are of the utmost importance due to the potential mimics that may occur. After identification of the entity, imaging must be performed to identify the etiology. Distinguishing external compression of the vertebral artery from intrinsic vascular disease due to atherosclerosis or dissection is critical to aid the clinician in the therapeutic decision tree. Patients with an external compression due to an osteophyte may benefit from definitive surgical decompression and excision of the bony structure. Patients with extracranial disease of the vertebral artery who have failed maximal medical therapy may benefit from angioplasty and stenting which appears to carry a low morbidity. Extracranial vertebral artery dissections can be treated with medical therapy using anti-platelet agents or on occasion anti-coagulation. Rarely, endovascular options are required if a patient is having hemodynamic stroke or TIAs due to flow failure. In such circumstances, stenting and angioplasty may be considered. Intracranial atherosclerosis is best managed with maximal medical therapy due to the high rate of complications attributable to stenting and angioplasty.

Diagnostic importance of phenotypic features of undifferentiated connective tissue dysplasia in spondylogenic vertebro-basilar insufficiency

“…The objective and methods of research: The analysis of the frequency of the individual constitutional and biological markers (CBM) of UCTD with SVBI was performed by comparing two groups: the first group of patients with SVBI (n = 136) and the control group (n 0 = 136)−practically healthy individuals, selected by the «copied-pair» method based on age and sex. The diagnosis of SVBI by duplex vessels scanning, MRI of the cervical spine, and sonography of vertebral, basilar arteries in the rest and after functional probes was verified (10,(18)(19)(20)(21).…”

The association between vertebrobasilar insufficiency and the risk of dementia: a nationwide register-based retrospective cohort study in Taiwan

“…All diagnoses of VBI were made on the basis of the clinical symptoms and signs with a focus on the cardiovascular and neurological systems and/or supporting imaging studies (Doppler ultrasonography, magnetic resonance angiography or CT angiography) from outpatient departments of participating hospitals and clinics. 22 For each patient with VBI, four insured subjects were selected randomly from subjects without a diagnosis of VBI in the LHID, as the non-VBI group, and were frequency-matched by sex, age and comorbidities that are known to be dementia risk factors and that were established before the index date. Selection according to comorbidities was based on outpatient data of the following ICD codes: hypertension (ICD-9-CM codes 401–405), diabetes (ICD-9-CM code 250), ischaemic heart disease (ICD-9-CM codes 410–414), hyperlipidaemia (ICD-9-CM code 272), tobacco use disorder (ICD-9-CM code 305.1), alcoholism (ICD-9-CM codes 291, 303.9, 334.4, 980.0), obesity (ICD-9-CM codes 278, 649.1, 783.1), atrial fibrillation (ICD-9-CM code 427.3), Parkinson’s disease (ICD-9-CM code 332.0), cerebral vascular accident (ICD-9-CM codes 430–432, 433–437), major depression (ICD-9-CM code 296), chronic kidney disease (ICD-9-CM code 585) and carotid artery insufficiency (ICD-9-CM code 433.1, 435.8).…”