Current management of vertebral basilar occlusive disease

The current medical and surgical management of vertebral basilar occlusive disease has been reviewed, with the emphasis on the lack of definitive data proving the absolute efficacy of one form of therapy. In addition, the renewed interest in medical and surgical therapy of the vertebral system has been displayed. More experience and detailed study should be directed towards the final solution of the best treatment for vertebral basilar insufficiency. The extracranial vascular procedure of choice for correcting a vertebral stenosis appears to be a vertebral to common carotid artery anastomosis. This therapy can be used for a subclavian steal syndrome, but the more established surgical therapy for a subclavian steal syndrome is a common carotid to subclavian bypass graft. The innovative microvascular techniques are too few in number of produce a definitive statement. However, the capability of these procedures has been well-demonstrated, and the patency rate is acceptable. On the other hand, these procedures are time consuming and, because they have been selected for patients who have failed in medical therapy, are tainted in that they are used with patients very difficult to manage successfully. With more aggressive diagnostic arteriographic study and renewed neurological interest in the vertebral basilar system, definite treatment regimens can be anticipated. Doubtless, the results of the extracranial-intracranial bypass study will have significant impact on our future approach.