Imaging of the pathology of the vertebral arteries

The vertebral arteries are among the most clinically important arteries in the body, providing blood flow to the posterior circulation of the brain. Both radiologists and clinicians need to understand the basic anatomy and the pathology that can affect the vertebral arteries in the acute and non-acute settings. Radiologists, in particular, need to be cognizant of the imaging findings of vertebral artery pathology as misdiagnosis of certain common conditions could be potentially disastrous. In this chapter, the embryology and anatomy of the vertebral arteries is reviewed, with a focus on normal variants and vascular territories. Vertebral artery diseases are then discussed, including atherosclerotic disease, vertebral artery dissection, subclavian steal syndrome, and a variety of other conditions. Each section is organized by epidemiology and clinical findings, pathophysiology, imaging findings, and work-up and management.