The Intracranial Vertebral Artery: A Neglected Species

Among posterior circulation arteries, the intracranial vertebral artery (ICVA) has been given the least attention, especially concerning treatment of occlusive lesions. Early clinicopathological studies showed that the ICVA was often occluded in patients with lateral medullary and posterior inferior cerebellar infarcts. Severe stenosis or occlusion of the ICVA was the most common arterial lesion among the 408 patients in the New England Medical Center Posterior Circulation Registry (NEMC-PCR). In this registry, the distal portion of the artery was most often involved, sometimes with spread into the basilar artery. ICVA occlusive lesions were often bilateral and very often accompanied by basilar and cervical vertebral artery occlusive lesions. Patients with bilateral ICVA occlusions often had attacks of dizziness, blurred vision, and ataxia during months and years but rarely later developed disabling infarction. Most posterior circulation infarcts in patients with ICVA occlusive lesions were located in the middle and distal posterior circulation territories and were rostral to the medulla and inferior cerebellum. Although diagnostic techniques now image the ICVA and its lesions well, the optimal treatment of patients with various ICVA occlusive lesions has very rarely been analyzed or reported. The therapeutics of patients with ICVA disease is uncharted territory and begs for attention and clarification.