Vertebrobasilar ischemia

Rosen BR, Belliveau JW, Vevea JM et al (1990) Perfusion imaging with NMR contrast agents. Magn Reson Med 14 249-265 Rother J, Wentz KU, Rautenberg W et al (1993) Magnetic resonance angiography in vertebrobasilar ischemia. Stroke 24 1310-1315... 

There is no good evidence (i.e. there are no large randomized trials) (Coward et al. 2005) that surgery improves the prognosis for patients with vertebrobasilar ischemia. There is, however, no shortage of ingenious, if technically demanding, techniques, which are far from risk free (Box 26.1). 

Frisoni GB, Anzola GP. Vertebrobasilar ischemia after neck motion. Stroke 1991 22(ll) 1452-60. 

Airway. Airway protection in stroke patients may require immediate intervention. An impaired level of consciousness combined with emesis can occur in patients with increased intracranial pressure (ICP) and posterior circulation stroke. Vertebrobasilar ischemia may affect medullary respiratory centers and cause apnea, or more commonly, paralysis of pharyngeal and tongue musculature leading to obstruction of the airway. The patient may require gastric suction and intubation to protect the airway from aspiration of gastric contents. An oral airway or nasal trumpet can be helpful if the patient has an upper airway obstruction. 

Few trials of antiplatelet agents have distinguished between different vascular territories or mechanisms of stroke, but there are some data on antiplatelet agents in posterior circulation disease. The Canadian Cooperative Study Group (1978) showed that aspirin reduced recurrent episodes of cerebral ischemia and death in patients with vertebrobasilar events. The European Stroke Prevention Study (ESPS Sivenius et al. 1991) of aspirin and immediate-release dipyridamole versus placebo appeared to show that patients with posterior circulation TIA benefited more than those with carotid disease, but the numbers of events were too small to be certain. 

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