DynaCT angiography for the diagnosis of bilateral bow hunter's syndrome

Tony Lu, Ponraj Chinnadurai, Javier E. Anaya-Ayala, Orlando M. Diaz

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


We herein present a rare case of bilateral positional vertebrobasilar insufficiency secondary to mechanical obstruction of the V2 segment of the vertebral artery in a 71-year-old patient presenting with vertigo, occipital headache, tremors and respiratory irregularities. Two-dimensional digital subtraction angiography is the traditional diagnostic imaging standard but does not capture any peri-vascular bony or soft tissue abnormalities that are important to understand the three-dimensional pathophysiology. Intra-procedural cone-beam computed tomography (CT) is an increasingly used diagnostic adjunct, available in most modern angiographic suites that allows for the three-dimensional visualization of the vasculature as well as CT-like soft tissue visualization of its surrounding anatomy. In this case, we report the additional value of three-dimensional reconstructed cone-beam CT angiographic imaging that led to the successful diagnosis of bilateral positional vertebrobasilar disease. The patient subsequently received C4-C6 cervical decompression and fusion and remains symptom free at 1 year follow-up.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalInterventional Neuroradiology
Issue number1
StatePublished - 2017


  • Bow hunter's syndrome
  • C-arm cone-beam CT
  • DynaCT
  • Vertebrobasilar insufficiency

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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