How are recurrent vertebrobasilar strokes prevented?

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

Answer

Strict risk factor control is important to decrease the risk of stroke recurrence. [43] Prevention strategies depend on the primary cause of the stroke. Patients with a definite cardioembolic source, such as atrial fibrillation, should be treated with warfarin to maintain an international normalized ratio of 2-3.

Treatment of patients with basilar artery stenosis and, for that matter, vertebral artery stenosis is less clear. Retrospective evidence suggests that warfarin is better than aspirin for the prevention of stroke recurrence in patients with greater than 50% basilar artery stenosis. The ongoing warfarin-aspirin trial for symptomatic intracranial disease will provide valuable information in that regard.

Several oral anticoagulant medications are in various stages of clinical trials for the prophylaxis of ischemic thromboembolic stroke. [44] If approved for use, the potential of such drugs in the arena of stroke treatment is significant.


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