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Vertebrobasilar Insufficiency

Definition

Vertebrobasilar insufficiency is poor blood flow to the back of the brain. This is due to damaged blood vessels (arteries). Blood flow to the back of the brain is supplied by two arteries of the neck. These two arteries join to form the basilar artery.

A decrease in blood flow can damage the brain and impair normal function.

Causes

Vertebrobasilar insufficiency is caused by a narrowing or damage of the arteries. The most common cause is atherosclerosis, a build-up of plaque in blood vessels. Plaque is a fatty substance in the blood.

Plaque buildup makes it hard for blood to flow through the blood vessels. In time, it can completely block the artery.

The blood vessels may also be damaged due to a birth defect.

Risk Factors

Things that can raise the risk of vertebrovascular insufficiency are:

Symptoms

Symptoms may include:

  • Vision problems
  • Headache
  • Lightheadedness or vertigo —sensation of spinning while standing still
  • Loss of coordination
  • Numbness or tingling, often in arms
  • Nausea or vomiting
  • Problems speaking
  • Sudden weakness

Diagnosis

The doctor will ask about symptoms and health history. A blood flow problem in the brain may be suspected based on symptoms.

Tests are done to confirm the diagnosis. Images of the blood vessels in the brain may be taken with:

An x-ray angiography may be done if the imaging tests are not clear. This can help the doctor see how much of the blood vessel is blocked. An MRI scan may also be done to see if a stroke has happened.

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Treatment

The goal of treatment is to reduce further damage to the blood vessels. It is also to decrease the risk of stroke. Options include:

Improving Heart Health

If the condition and symptoms are not severe, the doctor may advise:

  • Lifestyle changes—such as healthy diet, regular physical activity, and quitting smoking
  • Medicines to:
    • Lower blood pressure
    • Reduce cholesterol
    • Low the risk of blood clots and stroke

Surgical Options

More severe blockage or damage may require a procedure such as:

  • Angioplasty—a balloon is placed in the blood vessel to widen it
  • Stents—a device is placed in the blood vessel to keep it open
  • Open surgery (less common option), such as:
    • Endarterectomy —removes plaque build-up on the inside of the blood vessel
    • Bypass—A healthy piece of blood vessel is attached near the blockage—to re-route blood flow

Prevention

Heart healthy habits can help keep blood vessels healthy. They include:

  • Regular exercise.
  • Eating more fruits, vegetables, fish, and whole grains. Limiting dietary salt and fat.
  • Quitting smoking.
  • Drinking alcohol only in moderation. This means no more than 1 to 2 drinks per day.
  • Maintaining a healthy weight.
  • Keeping long term health problems under control. This includes high cholesterol, blood pressure, and diabetes.
  • Getting help for alcohol use disorder or drug abuse.
RESOURCES:

American Heart Association
http://www.heart.org

National Stroke Association
http://www.stroke.org

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

REFERENCES:

Lima Neto AC, Bittar R, et al. Pathophysiology and diagnosis of vertebrobasilar insufficiency: a review of the literature. Int Arch Otorhinolaryngol. 2017;21(3):302-307.

Vertebral artery stenosis and occlusion. EBSCO Dynamed website. Available at: https://www.dynamed.com/condition/vertebral-artery-stenosis-and-occlusion. Accessed July 19, 2021.

Vertebro basilar insufficiency. Nebraska Medicine website. Available at: https://www.nebraskamed.com/neurosurgery/vertebral-basilar-insufficiency. Accessed July 19, 2021.

Vertebrobasilar insufficiency. UC Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/vascular/diseases/vertebrobasilar.html. Accessed July 19, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 7/19/2021