Doss Arockia, Phatouros Constantine C
Department of Radiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney NSW 2050, Australia.
Curr Treat Options Cardiovasc Med. 2006 Apr;8(2):111-9. doi: 10.1007/s11936-006-0003-0.
Vertebrobasilar insufficiency presents with characteristic symptoms and signs due to impaired perfusion of the cerebellum, the brain stem, and the occipital cortex. This may be due to reduced perfusion usually due to atherosclerosis or thromboembolism. Choice of treatment depends on understanding the different underlying pathophysiologic mechanisms. Antiplatelet therapy; reduction of risk factors such as diabetes, hypertension, hypercholesterolemia, and cigarette smoking; and a healthy lifestyle form the first line of management. Systemic anticoagulation in the short term also has a key role in selected cases. In patients with refractory symptoms on maximal medical therapy and underlying focal stenotic lesions, endovascular revascularization using stents and balloon angioplasty may be indicated. Bypass surgery is another option if there are factors that render endovascular therapy unsuitable.
椎基底动脉供血不足由于小脑、脑干和枕叶皮质灌注受损而出现特征性症状和体征。这可能是由于通常由动脉粥样硬化或血栓栓塞导致的灌注减少。治疗方案的选择取决于对不同潜在病理生理机制的理解。抗血小板治疗；降低糖尿病、高血压、高胆固醇血症和吸烟等危险因素；以及健康的生活方式构成了一线治疗方法。短期全身抗凝在特定病例中也起着关键作用。对于接受最大程度药物治疗后仍有难治性症状且存在潜在局灶性狭窄病变的患者，可能需要采用支架和球囊血管成形术进行血管内血运重建。如果存在使血管内治疗不适用的因素，搭桥手术是另一种选择。
