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Purpose of review <p>Vertebrobasilar dolichoectasia (VBD) is a vascular pathology characterized by elongation, dilation, and/or tortuosity of the vertebrobasilar arterial system. Clinical presentations of VBD are variable, commonly including ischemia, hemorrhage, and symptomatic mass effect. This review explores the pathophysiology, clinical features, and diagnostic approach to VBD-related cerebrovascular disease and other clinical complications. In addition, we examine current trends in both preventative and acute management strategies.</p> Recent Findings <p>Diagnosis of VBD is dependent upon specific imaging criteria with emphasis on anatomical characteristics and associated imaging findings, such as white matter disease and microhemorrhages, that may provide prognostic value. To date, there is no consensus for primary stroke prevention within VBD, with some evidence for the use of antithrombotic agents for secondary stroke prevention. There are no specific guidelines on choice of antithrombotic, whether antiplatelet or anticoagulation, and this decision should be individualized based on symptom severity, associated comorbidities, and anatomic characteristics of the lesion. In cases of deterioration or progression despite optimal medical management, endovascular and surgical interventions can be considered. Acute management of cerebrovascular events may include intravenous thrombolytics, anticoagulation, and/or endovascular interventions. For compressive symptoms that are refractory to medical management, microvascular decompression techniques can be considered.</p> Summary <p>VBD may manifest in a variety of neurological syndromes, though cerebrovascular events represent the most commonly encountered clinical phenomenon. With ongoing research, our understanding of the underlying pathogenic mechanisms of this disease continues to grow and will continue to influence our prevention and therapeutic approaches. For now, there is no consensus on primary stroke prevention in VBD with some evidence for the use of antithrombotic agents for secondary prevention. Further studies will help clarify the pathogenic underpinnings of VBD and enhance primary and secondary prevention strategies, with the aim of reducing morbidity and mortality within this population.</p>

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Update on Management in Patients with Vertebrobasilar Dolichoectasia

  • 期刊论文

  • 发表日期：

    2025年9月12日

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  • Helena K. Xeros,
  • Carlee Oakley,
  • Giuseppe Lanzino,
  • Rafid Mustafa

摘要

Purpose of review

Vertebrobasilar dolichoectasia (VBD) is a vascular pathology characterized by elongation, dilation, and/or tortuosity of the vertebrobasilar arterial system. Clinical presentations of VBD are variable, commonly including ischemia, hemorrhage, and symptomatic mass effect. This review explores the pathophysiology, clinical features, and diagnostic approach to VBD-related cerebrovascular disease and other clinical complications. In addition, we examine current trends in both preventative and acute management strategies.

Recent Findings

Diagnosis of VBD is dependent upon specific imaging criteria with emphasis on anatomical characteristics and associated imaging findings, such as white matter disease and microhemorrhages, that may provide prognostic value. To date, there is no consensus for primary stroke prevention within VBD, with some evidence for the use of antithrombotic agents for secondary stroke prevention. There are no specific guidelines on choice of antithrombotic, whether antiplatelet or anticoagulation, and this decision should be individualized based on symptom severity, associated comorbidities, and anatomic characteristics of the lesion. In cases of deterioration or progression despite optimal medical management, endovascular and surgical interventions can be considered. Acute management of cerebrovascular events may include intravenous thrombolytics, anticoagulation, and/or endovascular interventions. For compressive symptoms that are refractory to medical management, microvascular decompression techniques can be considered.

Summary

VBD may manifest in a variety of neurological syndromes, though cerebrovascular events represent the most commonly encountered clinical phenomenon. With ongoing research, our understanding of the underlying pathogenic mechanisms of this disease continues to grow and will continue to influence our prevention and therapeutic approaches. For now, there is no consensus on primary stroke prevention in VBD with some evidence for the use of antithrombotic agents for secondary prevention. Further studies will help clarify the pathogenic underpinnings of VBD and enhance primary and secondary prevention strategies, with the aim of reducing morbidity and mortality within this population.