How is vertebrobasilar stroke treated?

Updated: Mar 03, 2020
  • Author: Vladimir Kaye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Other aspects of treatment for vertebrobasilar stroke should include the following:

  • Aggressive pulmonary toilet to prevent mucous congestion and pneumonia

  • Prevention of aspiration pneumonitis

  • Early establishment of bowel and bladder programs

  • Monitoring of skin and all indwelling catheters for signs of infection

  • Control of body temperature (fever may worsen the outcome in stroke patients)

  • Tight blood glucose control

  • Heel protectors or L'Nard Multi Podus boots with regular skin inspection for breakdown/decubitus

  • Deep vein thrombosis prophylaxis with sequential compression devices or arteriovenous pumps and/or anticoagulants (eg, low–molecular weight heparin; adjusted-dose, subcutaneous heparin; warfarin), provided that there are no contraindications

A study by Alexander et al indicated that symptomatic vertebrobasilar atherosclerosis can be safely and effectively treated with endovascular therapy. The study involved interventions for 136 lesions (122 patients), including 13 treatments for acute stroke. The investigators found that treatment was technically successful for 123 of the lesions (90.4%), with better technical results achieved in cases of extracranial disease. Patients with nonprogressive symptoms in the subacute period and individuals who underwent statin treatment had better clinical results. [39]

Similarly, a retrospective study by Piechowiak et al indicated that endovascular treatment is a safe and effective therapy for tandem vertebrobasilar occlusion (ie, a basilar artery occlusion combined with proximal stenosis). The investigators found that of 52 patients with acute vertebrobasilar occlusive stroke who underwent mechanical thrombectomy, 8 of the 15 individuals (53.3%) with a tandem occlusion had a favorable outcome, while favorable results were obtained in 4 out of 14 patients (28.6%) with a single basilar artery occlusion with underlying stenosis and 5 out of 23 patients (21.7%) with an isolated embolic basilar artery occlusion. [40]

A study by Laible et al indicated that in patients with vertebrobasilar stroke who undergo thrombectomy, the presence of renal dysfunction increases the chance for posttreatment intracerebral hemorrhage (odds ratio = 3.54). However, the investigators did not find that either renal dysfunction or intracerebral hemorrhage was associated with an increased 3-month mortality risk in these patients. [41]


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