Understanding Vertebral Artery Stenosis

What is vertebral artery stenosis?

Within your neck are two pairs of large blood vessels, called carotid and vertebral arteries, which carry blood to your brain.

The vertebral arteries are located at the back of the neck. They come together at the base of the brain to form one artery called the basilar artery. Together these arteries, jointly known as the "vertebrobasilar artery system," supply blood to the parts of the brain that control movement, balance, reflexes, breathing, blood pressure and other functions.

If you were to look inside a healthy vertebral artery, it would appear smooth and wide open, providing easy passage for the blood flowing to your brain. However, due to normal aging or unhealthy lifestyle choices, one or more of your vertebral arteries can become clogged with plaque, a sticky substance made up of cholesterol, calcium and other materials.

Over time, as plaque continues to build up on your vertebral artery walls, the vessels can become so congested that blood has a hard time passing through them. This is a condition called vertebral artery stenosis, also known more broadly as vertebrobasilar disease or vertebrobasilar insufficiency.

Because vertebral artery stenosis can reduce or even block blood flow to your brain, it significantly increases your risk of developing a stroke or transient ischemic attack (TIA).

What are the symptoms of vertebral artery stenosis?

Many people with vertebral artery stenosis do not experience symptoms until it has reached an advanced stage, meaning there is not enough blood flow to the brain. Because the vertebral arteries carry blood to parts of the brain that control movement and balance, many people experience symptoms that increase their risk of falling down.

These symptoms often develop gradually but can get worse over time, and include:

• dizziness or vertigo
• sudden, unexplained falls that occur without loss of consciousness (known as "drop attacks")
• sudden, severe weakness in the legs that can cause falls
• trouble seeing in one or both eyes, including blurred or double vision
• trouble speaking, including slurred speech
• confusion, including problems understanding speech
• trouble swallowing

If your vertebral artery stenosis is severe enough to cause a stroke or TIA, you may experience the following sudden symptoms:

• numbness, weakness or paralysis in an arm, leg or your face, especially on one side of the body
• trouble speaking, including slurred speech
• confusion, including problems understanding speech
• trouble seeing in one or both eyes, including blurred or double vision
• severe headache, with or without vomiting
• dizziness
• loss of balance or coordination, including trouble walking
• breathing problems
• loss of consciousness

Stroke is a medical emergency. If you experience any of these sudden symptoms, please call 911 immediately.

Who is at risk for vertebral artery stenosis?

There are several risk factors that can increase your likelihood of developing vertebral artery stenosis. These include:

• smoking
• high cholesterol
• high blood pressure
• obesity
• diabetes
• sedentary lifestyle (lack of exercise or other physical activity)
• a family history of vertebral artery stenosis

Risk also increases with age for both men and women, especially over 50.

How is vertebral artery stenosis diagnosed?

If your doctor suspects you have vertebral artery stenosis, he or she will order one or more of the following tests:

• Ultrasound is a painless test that uses sound waves to produce pictures of your vertebral arteries, and confirm whether plaque has built up inside of them. The procedure is sometimes combined with Doppler ultrasound, which shows how well blood is moving through your vertebral arteries. While ultrasound tests can detect many cases of vertebral artery stenosis, they often are performed in combination with one of the tests below to more precisely assess what is happening inside your arteries.
• A computerized tomography (CT) scan captures X-ray images of your brain and vertebral arteries. Your doctor may pair this scan with a special dye injected into your blood stream, so he or she can observe how well blood is flowing through your vertebral arteries and into your brain. This is called CT angiography.
• A magnetic resonance imaging (MRI) scan captures 3-D images of your brain and blood vessels. Your doctor may use a variation of this test, called MR angiography or MRA, to show the vertebral arteries in greater detail.
• Cerebral angiography is a minimally invasive test that combines X-rays and a special dye to see inside the arteries in your brain.

How is vertebral artery stenosis treated?

If you've been diagnosed with vertebral artery stenosis, your doctor will create a treatment plan for you that is based on several factors, including the severity of your condition, whether or not you're experiencing symptoms and your overall health.

In addition to prescribing medication and lifestyle changes, your doctor may recommend one of the following procedures:

• Endarterectomy is a well-studied surgical procedure that has been used to treat narrowed or blocked arteries since the 1950s. During the procedure a surgeon makes an incision in the neck, opens the affected vertebral artery, and removes any plaque that is blocking the vessel.
• Angioplasty and stenting is a minimally invasive procedure that does not require open surgery. During the procedure, a surgeon threads a small, flexible tube called a catheter through an artery (usually starting in the groin area) until it reaches the carotid artery. The catheter is used to inflate the narrowed artery with the aid of a tiny balloon, and then insert a tiny device called a stent to keep the artery propped open.
• Vascular bypass surgery, also known as bypass grafting, is an open surgical procedure that allows your doctor to create a detour around the narrowed or blocked portion of the artery. This "bypass," made from one of your own veins or from synthetic material, allows blood to flow around the blockage.
• Vertebral artery reconstruction is a surgical procedure that allows your doctor to move a portion of the vertebral artery to an adjacent, healthy artery and sew the two together.

Vertebral artery stenosis care at Lyerly Neurosurgery

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition, including those who are at increased risk of stroke due to underlying conditions such as vertebral artery stenosis.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

Together with Baptist Medical Center Jacksonville, our team performs emergency and preventive surgical services including vertebral artery angioplasty and stenting, endarterectomy and vascular bypass surgery.