Vertebrobasilar insufficiency medical therapy: Difference between revisions

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==Overview==
==Overview==
Patients should discuss with their physician possible causes for their VBI symptoms.  As discussed above, postural changes, exercise, and [[dehydration]] are some of the likely culprits.  Treatment usually involves lifestyle modifications.  For example, if VBI is attributed mainly to postural changes, patients are advised to slowly rise to standing position after sitting for a long period of time.  An appropriate exercise regimen for each patient can also be designed in order to avoid the excessive pooling of blood in the legs.  Dehydrated patients are often advised to increase their water intake, especially in hot, dry climates.  Finally, when applicable, patients are often advised to stop smoking and to control their hypertension, diabetes, and cholesterol level. 
In the recent decades, interventional therapy became more and more important with the medical therapy as the foundation of the whole treatment.Open surgery is rarely used because its high risk of complication comparing with the catheter-based therapy.
 
In the event that a patient suffers a “drop attack,” and especially for the elderly population, the most important action is to be evaluated for associated head or other injuries.  To prevent drop attacks, patients are advised to “go to the ground” before the knees buckle and shortly after feeling dizzy or experiencing changes in vision.  Patients should not be concerned about the social consequences of suddenly sitting on the floor, whether in the mall or sidewalk, as such actions are important in preventing serious injuries.  
 
Sometimes, to prevent further occlusion of blood vessels, patients are started on an antiplatelet agent ([[aspirin]], clopidogrel, or [[aspirin]]/[[dipyridamole]]) or sometimes an[[anticoagulant]] ([[warfarin]]) once hemorrhage has been excluded with imaging.
 
==Medical Therapy==
==Medical Therapy==
[[Aspirin]] and other [[antiplatelet drug]] have been used to treat vertebrobasilar
The principle of medical therapy is reducing the atherosclerotic and thrombotic risk.
disease. however, none of the drug used in the treatment of VBI has been evaluated in the ramdomized controlled trials.
1.Aspirin (75 to 325 mg daily) is strongly recommended to prevent ischemic events, if there is no contraindications.
For patients with acute ischemic syndromes that
2.If the patient is suitable to accept asprin due to contraindictions, clopidogrel (75 mg daily) or ticlopidine (250 mg twice daily) is suggested to treat the atherosclerosis of the extracranial vertebral arteries.
involve the vertebral artery territory and angiographic
3.3 chemes is suggested to treat the patients with persisitently ischemic [[stroke]] or [[TIA]] due to extracranial vertebral atherosclerosis.
evidence of thrombus in the extracranial portion of the
  (1).Aspirin (81 to 325 mg daily)
vertebral artery, [[anticoagulation]] is generally recom-
  (2).Aspirin (81 to 325 mg daily) combinated with the  extended-release dipyridamole (25 and 200 mg twice daily)
mended for at least 3 months, whether or not thrombo-
  (3).clopidogrel (75 mg daily).<ref name="pmid23281092">Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al. (2013) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23281092 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography.] ''Catheter Cardiovasc Interv'' 81 (1):E76-123. [http://dx.doi.org/10.1002/ccd.22983 DOI:10.1002/ccd.22983] PMID: [http://pubmed.gov/23281092 23281092]</ref>
lytic therapy is used initially<ref name="pmid15972868">Savitz SI, Caplan LR (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15972868 Vertebrobasilar disease.] ''N Engl J Med'' 352 (25):2618-26. [http://dx.doi.org/10.1056/NEJMra041544 DOI:10.1056/NEJMra041544]PMID: [http://pubmed.gov/15972868 15972868]</ref><ref name="pmid12777203">Caplan LR (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12777203 Atherosclerotic Vertebral Artery Disease in the Neck.] ''Curr Treat Options Cardiovasc Med'' 5 (3):251-256. PMID:[http://pubmed.gov/12777203 12777203]</ref><ref name="pmid16988872">Canyigit M, Arat A, Cil BE, Sahin G, Turkbey B, Elibol B (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16988872 Management of vertebral stenosis complicated by presence of acute thrombus.]''Cardiovasc Intervent Radiol'' 30 (2):317-20. [http://dx.doi.org/10.1007/s00270-006-0016-9 DOI:10.1007/s00270-006-0016-9] PMID: [http://pubmed.gov/16988872 16988872]</ref><ref name="pmid16197822">Eckert B (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16197822 Acute vertebrobasilar occlusion: current treatment strategies.] ''Neurol Res'' 27 Suppl 1 ():S36-41. [http://dx.doi.org/10.1179/016164105X25324 DOI:10.1179/016164105X25324] PMID: [http://pubmed.gov/16197822 16197822]</ref>  The WASID (War-
farin versus [[Aspirin]] for Symptomatic Intracranial Dis-
ease) trial found [[aspirin]] and [[warfarin]] to be equally
efficacious after initial noncardioembolic ischemic
stroke<ref name="pmid17030766">Kasner SE, Lynn MJ, Chimowitz MI, Frankel MR, Howlett-Smith H, Hertzberg VS et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17030766 Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID.] ''Neurology'' 67 (7):1275-8.[http://dx.doi.org/10.1212/01.wnl.0000238506.76873.2f DOI:10.1212/01.wnl.0000238506.76873.2f] PMID: [http://pubmed.gov/17030766 17030766]</ref><ref name="pmid10953174">Benesch CG, Chimowitz MI (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10953174 Best treatment for intracranial arterial stenosis? 50 years of uncertainty. The WASID Investigators.] ''Neurology'' 55 (4):465-6. PMID: [http://pubmed.gov/10953174 10953174]</ref>  Ticlopidine was superior to [[aspirin]] for
secondary prevention of ischemic events in patients
with symptomatic posterior circulation disease.<ref name="pmid1734290">Grotta JC, Norris JW, Kamm B (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1734290 Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup.] ''Neurology'' 42 (1):111-5. PMID: [http://pubmed.gov/1734290 1734290]</ref>


==References==
==References==

Revision as of 05:55, 11 December 2013

Vertebrobasilar insufficiency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In the recent decades, interventional therapy became more and more important with the medical therapy as the foundation of the whole treatment.Open surgery is rarely used because its high risk of complication comparing with the catheter-based therapy.

Medical Therapy

The principle of medical therapy is reducing the atherosclerotic and thrombotic risk. 1.Aspirin (75 to 325 mg daily) is strongly recommended to prevent ischemic events, if there is no contraindications. 2.If the patient is suitable to accept asprin due to contraindictions, clopidogrel (75 mg daily) or ticlopidine (250 mg twice daily) is suggested to treat the atherosclerosis of the extracranial vertebral arteries. 3.3 chemes is suggested to treat the patients with persisitently ischemic stroke or TIA due to extracranial vertebral atherosclerosis. 

 (1).Aspirin (81 to 325 mg daily)
 (2).Aspirin (81 to 325 mg daily) combinated with the  extended-release dipyridamole (25 and 200 mg twice daily)
 (3).clopidogrel (75 mg daily).[1]

References

  1. ↑ Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al. (2013) 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv 81 (1):E76-123. DOI:10.1002/ccd.22983 PMID: 23281092

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