title: DynaCT angiography for the diagnosis of bilateral bow hunter's syndrome.
abstract: 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.
authors: 1 Division of Vascular and Endovascular Surgery, Houston Methodist Hospital, USA.
authors: Tony
authors: T
authors: Lu
authors: 2 Angiography Division, Siemens Medical Solutions USA Inc., USA.
authors: Ponraj
authors: P
authors: Chinnadurai
authors: 1 Division of Vascular and Endovascular Surgery, Houston Methodist Hospital, USA.
authors: Javier E
authors: JE
authors: Anaya-Ayala
authors: 3 Departments of Neurosurgery and Radiology, Houston Methodist Hospital, USA.
authors: Orlando M
authors: OM
authors: Diaz
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D006801:Humans; D013577:Syndrome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: C-arm cone-beam CT; DynaCT; Vertebrobasilar insufficiency; bow hunter’s syndrome