Diagnosis:
- Ongoing ischemic events in the territory supplied by the vertebral artery despite occlusion of the vertebral artery
- Must be differentiated from intracranial atherosclerotic disease (ICAD), small vessel disease and other competing stroke mechanisms
Pathophysiology:
- Emboli travel to the posterior circulation in the distribution of the affected vertebral artery via collaateral pathways.
Treatment:
Medical therapy:
- This is first line therapy with antiplatelets
Consider Endovascular therapy:
- Consider if recurrent events in spite of medical therapy
- Coiling of the distal segment of the vertebral artery
- Or Endovascular occlusion of collaterals