Vertebral Artery Occlusion Mechanisms and Management Strategies

Vertebral artery occlusion encompasses a spectrum of pathologies in which blood flow through one or both vertebral arteries is compromised, leading to vertebrobasilar insufficiency and posterior circulation ischaemia. Mechanisms include dynamic compression by osseous or soft‐tissue structures at the craniovertebral junction, intrinsic arterial dissection or stenosis, atherosclerotic plaque burden, and rare vascular variants. Symptoms range from transient dizziness, syncope and vertigo to focal neurological deficits, seizures and posterior fossa infarction. Diagnosis relies on dynamic vascular imaging—computed tomography angiography or magnetic resonance angiography during provoked head movements, catheter digital subtraction angiography with rotational manoeuvres, and Doppler ultrasonography. Management strategies span conservative medical therapy with antiplatelet or anticoagulant agents and cervical immobilisation, through endovascular interventions such as balloon angioplasty or coil embolisation, to surgical techniques including decompression at the atlas‐axis junction, anterior cervical discectomy and fusion, or ancillary procedures like laryngoplasty. The choice of intervention is guided by the underlying aetiology, symptom severity and patient fitness, with the goal of restoring or maintaining uninterrupted posterior circulation flow while minimising procedural risk.

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Vertebral Artery Occlusion Mechanisms and Management Strategies publication trend

The graph below shows the total number of articles in vertebral artery occlusion mechanisms and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Bow Hunter’s syndrome: Rotational vertebral artery occlusion by cervical movement leading to transient posterior circulation ischaemia.

Vertebrobasilar insufficiency: Reduced blood flow in the posterior circulation resulting in brainstem and cerebellar hypoperfusion.

Dynamic angiography: Vascular imaging performed during head rotation or extension to provoke and visualise arterial occlusion.

Endovascular coil embolisation: Intracranial technique to occlude a vessel segment by deploying coils to prevent distal embolism.

Anterior cervical discectomy and fusion (ACDF): Surgical removal of a cervical intervertebral disc and stabilisation using bone graft or spacer to prevent movement.

References

1. Recurrent posterior circulation infarction caused by anomalous occipital bony process in a young patient. BMC Neurology (2014).
2. Thyroid Cartilage Compression Causing Bow Hunter’s Syndrome. Annals of Otology Rhinology & Laryngology (2022).
3. Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature. Cureus (2021).