Vertebrobasilar insufficiency medical therapy

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

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 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 ananticoagulant (warfarin) once hemorrhage has been excluded with imaging.

Medical Therapy

Aspirin and other antiplatelet drug have been used to treat vertebrobasilar disease. however, none of the drug used in the treatment of VBI has been evaluated in the ramdomized controlled trials. For patients with acute ischemic syndromes that involve the vertebral artery territory and angiographic evidence of thrombus in the extracranial portion of the vertebral artery, anticoagulation is generally recom- mended for at least 3 months, whether or not thrombo- lytic therapy is used initially 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 Ticlopidine was superior to aspirin for secondary prevention of ischemic events in patients with symptomatic posterior circulation disease.