Vertebrobasilar atherosclerotic disease: is it time to revisit angioplasty?

Atherosclerotic occlusive disease of the vertebrobasilar (VB) system is an important cause of posterior circulation ischemic stroke, responsible for approximately one-third of cases,1 and associated with high morbidity. Despite medical therapy, the risk of recurrent stroke is significant, particularly for intracranial VB disease, ranging from 10% to 15% per year.2 The role of hemodynamic insufficiency in the etiology of stroke from VB stenosis/occlusion has long been purported, but until recently, there have been few data to directly support this mechanism. Traditional tissue-based imaging techniques for evaluation of hemodynamic compromise, including MR and CT perfusion, have significant limitations in assessing the more compact posterior circulation territory. Thus measurement of large vessel flow in the stenotic artery and major collateral vessels is an attractive surrogate strategy for hemodynamic assessment, which can be performed non-invasively using phase contrast quantitative magnetic resonance angiography (QMRA). Such measurements can be performed...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Commentary Source Type: research