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This results in dynamic impingement upon the vessel lumen, compromising flow to the posterior circulation and provoking typical features of vertebrobasilar insufficiency.
Updating the 2000 first edition, they incorporate recent research questioning the appropriateness of a number of commonly used vertebrobasilar insufficiency protocols, and evidence for using spinal manipulation in patients with disc lesions.
Forty-one of the patients (37%) showed signs of vertebrobasilar insufficiency, and 29 patients (26%) had disabling chronic arm ischemia prior to PTA.