Abstract 2225: Vertebral Artery Stenting for the Treatment of Bow Hunter Syndrome: a report of four cases.

Abstract

Background: Bow Hunter syndrome is a rare condition that results from vertebrobasilar insufficiency secondary to mechanical occlusion or stenosis of the vertebral artery due to head rotation. Traditionally, surgical intervention with C1-C2 fusion or decompression of the vertebral artery was the mainstay of therapy. Endovascular intervention was rarely described for the treatment of bow hunter syndrome. Methods: The neurointerventional database between July 2005 and October 2010 was reviewed for identification of all cases of bow hunter syndrome that were treated with vertebral artery stenting. We report clinical, technical and outcome data on four patients with bow hunter syndrome who were treated with vertebral artery stenting. Results: Vertebral artery stenting was performed in the V2 segment (C2-C6) of the vertebral arteries in all four patients without significant technical difficulties. All patients reported symptomatic relief with minor or no residual stenosis on dynamic digital subtraction angiography. Conclusion: Vertebral artery stenting for the treatment of Bow Hunter syndrome is feasible, safe, and clinically effective. Endovascular techniques might offer an alternative and a minimally invasive therapy for the treatment of bow hunter syndrome. Figure 1 . Case #1. (A) Selective left subclavian angiogram showing the left vertebral artery with head in neutral position. (B) Narrowing of the V2 segment with head turned to the left. (C) Post-stenting of the V1 (origin) and V2 segments with head turned to the left.