This section refers to extracranial vertebral artery stenosis due to atherosclerotic disease
Diagnosis:
Must exclude other etiologies of stroke: including intracranial atherosclerotic disease
Catheter angiography:
- Gold standard test
- Allows accurate determination of degree of stenosis and collateral pathways
- Allows determination of intracranial disease
MRA
CTA
Ultrasound: is if insufficient sensitivity to exclude the diagnosis
Treatment:
Antiplatelet therapy and risk factor control in all patients with extracranial vertebral artery stenosis
Asymptomatic disease:
- Very low stroke risk in asymptomatic disease on antiplatelet therapy
Address risk factors
Antiplatelets:
- Aspirin with or dipyridamole
- Or clopidogrel
Consider endovascular intervention (angioplasty +stenting):
- Consider if failing medical therapy
- Heparin during procedure
- Aspirin +clopidogrel for 3 months