Introduction: Introduction and Methods: This presentation is a review of 70 years of literature of PCD.

Methods: Review of Literature of Last 70 years

Results: Results: The pathology of atherosclerosis in the posterior demonstrates differences between each vertebral, stenosis of smaller arteries than the carotids leading to earlier symptomology, VB stenosis is 50% higher in the PC than AC, less ulcerated plaques found in the PC, thrombus occurs on these plaques that can embolize, and the less the collateral in the PC the higher the disease process. Occlusion of one vertebral does not assure adequate circulation. Studies on Subclavian Steal prove that PCD symptoms can be hemodymanic. Clinically, PCD has symptoms for up to 6 months prior to infarct, a rapid onset with greater risk than ACD. No large clinical studies or Registries have been done without some bias in patient selection. Thus, the natural history of PCD is not known. The National Stroke Guidelines for symptoms are too late to treat the disease. Medical treatment has been based on carotid disease treatment. Imaging relying on CT and 3 T MR technologies is inadequate to show lesions in the PC. Angiography is still the gold standard of diagnosis. Interventional therapy has not been successful in PCD. Surgical treatment of vertebral origin disease has a 94% success rate. EC-IC bypass surgery was discarded with the EC-IC Bypass Study, when PCD was not even studied. EC-IC Bypass studies for intracranial disease collectively show 80% improvement in symptoms or cure. All surgical patients failed maximal medical therapy, representing a subset of PCD. The longer one waits to defer to surgery the higher the risks of surgery become. Recent evidence from RCT show that using Quantative MR Angiography flow technology, those with normal flows can be differentiated from those with low flows, who have a high risk for infarction. Surgery for the latter group normalizes their outcomes. 7Tesla MRA will surpass IA angiography in detail but is not commonly available

Conclusions: Conclusions: The Vertebral basilar circulation is totally different than that of the Anterior Circulation. New Diagnostic and Management approaches are necessary.

Patient Care: By encouraging clinicians to think differently about Vertebral Basilar Disease

Learning Objectives: THe Management of Anterior and Posterior Circulation Disease should be different

References: On Demand (130)