A Case of Bow Hunter's Stroke
Treated with Endovascular Surgery

This section is compiled by Frank M. Painter, D.C.
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FROM:   No Shinkei Geka 2006 (Feb);   34 (2):   189192

Gomi M, Hattori I, Horikawa F, Iwasaki K

Department of Neurosurgery,
National Hospital Organization
Himeji Medical Center,
Hyougo, Japan

Bow hunter's stroke results from vertebrobasilar insufficiency due to a mechanical occlusion or stenosis of the vertebral artery caused by head rotation. We report here a case of bow hunter's stroke that was successfully treated with endovascular surgery. A 69-year-old male complained of intractable vertigo when he rotated his head to the right side. Neuroradiological studies proved that the symptom was attributed to the mechanical severe stenosis of the left vertebral artery at the C1-C2 level on head rotation, in addition to the atherosclerotic stenosis at the origin of the right vertebral artery. Two different treatments were considered, including direct surgeries to prevent the mechanical stenosis of the left vertebral artery, and an endovascular dilatation of the atherosclerotic stenosis of the right vertebral artery. Endovascular surgery with a stenting technique, which was thought to be less invasive, was undertaken and resulted in a complete relief of the patient's symptom. To our knowledge, this is the first report to have shown the efficacy of endovascular surgery on this uncommon disease.

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