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Updated: May 13, 2026
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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Bilateral mechanical rotational vertebral artery occlusion
Phong T Dargon1, Conrad W Liang, Anmol Kohal
1Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore.
Journal of Vascular Surgery
|March 8, 2013
Summary
Bow hunter's stroke, a type of positional vertebrobasilar ischemia, can occur from bilateral vertebral artery occlusion. Surgical decompression resolved symptoms in a rare case of dynamic bilateral occlusion.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Rotational vertebral artery occlusion, or bow hunter's stroke, is a reversible condition causing vertebrobasilar insufficiency.
- It typically results from obstruction of a dominant vertebral artery during head rotation, often with contralateral stenosis or occlusion.
Observation:
- A rare case presented with near syncope upon rightward head rotation, caused by mechanical occlusion of bilateral patent vertebral arteries.
- Cerebral angiography revealed dynamic occlusion at the right C5 and left C2 vertebral artery levels.
Findings:
- The patient underwent surgical decompression of the right C4/5 transverse process.
- Postoperative angiography demonstrated restored patency of the right vertebral artery in neutral and rotated head positions.
Implications:
- This case highlights a rare mechanism of bow hunter's stroke involving bilateral vertebral arteries.
- Surgical intervention can effectively treat symptomatic dynamic bilateral vertebral artery occlusion, resolving neurological deficits.
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