About Vertebrobasilar Disease
Vertebrobasilar disease is a disease of the arterial system. It describes a variety of conditions affecting blood flow to the back of the brain via the vertebral and/or basilar arteries.
Blood is delivered to several structures in the brain, particularly those responsible for movement and balance, via the carotid arteries (large vessels on each side of the neck) and vertebral arteries. The vertebral arteries are located at the back of the neck and merge at the base of the brain to form the basilar artery.
Causes and Risk Factors
Atherosclerosis or "hardening of the arteries" is the main cause of vertebrobasilar disease. The narrowing of the vertebral or basilar arteries caused by atherosclerosis creates vertebrobasilar insufficiency (VBI), or an insufficient delivery of blood flow to the posterior structures of the brain.
Patients with vertebrobasilar disease are at increased risk for transient ischemic attack (TIA) and stroke. Transient ischemic attack or "mini strokes" create stroke-like symptoms that resolve themselves in less than 24 hours. Strokes, however, that occur in this portion of the brain are particularly devastating and often result in death.
Vertebrobasilar disease is twice as common in men than women and typically occurs in the elderly. However, there is increased risk for earlier onset among people with risk factors relating to atherosclerotic disease including:
- Diabetes
- Hypertension
- Obesity
- High cholesterol
- Smoking
- Advanced age
- Inactive lifestyle
Symptoms
As a result of decreased blood flow, and because vertebrobasilar disease affects so many separate structures of the brain, symptoms are varied and often referred to as a whole as vertebrobasilar insufficiency (VBI) or vertebral basilar ischemia (lack of blood flow to an organ).
Common symptoms include:
- Vertigo (dizziness)
- Visual disturbances (blurring, graying, double vision)
- Sudden falls
- Numbness or tingling
- Slurred or lost speech
- Confusion
- Issues with swallowing
Diagnosis
Diagnostic tests to confirm vertebrobasilar disease include magnetic resonance angiography or standard angiography, both of which use an injected dye to track the flow of blood and are useful in identifying areas of stenosis or narrowing within a blood vessel.
Treatment Options
The first step for an individual with vertebrobasilar disease is lifestyle modification, which includes exercise, smoking cessation, eating a low-cholesterol diet and controlling diabetes. Medications to help control cholesterol and platelet function may also be required, such as aspirin, Plavix™, Lipitor™ and Zocor™.
The Vertebral Artery Clinic at the University of Michigan Frankel Cardiovascular Center offers patients the full gamut of surgical and endovascular treatment options.
Surgical Options
- Endarterectomy: The procedure involves the surgical removal of plaque from the affected artery
- Bypass grafting
- Vertebral artery reconstruction
Endovascular Options
Angioplasty and Stenting: Angioplasty is a procedure in which a catheter-guided balloon is used to open a narrowed coronary artery. A stent (a wire-mesh tube that expands to hold the artery open) is usually placed at the narrowed section during angioplasty.
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