Three Consecutive Embolic Basilar Artery Occlusions Due to Bow Hunter’s Syndrome, Causing a Dissection of the Right Vertebral Artery: Surgical Treatment with Excellent Outcome

A patient with thromboembolic basilar artery occlusion received endovascular thrombectomy and was subsequently diagnosed with spontaneous dissection of the right vertebral artery. Conservative treatment of the dissection did not improve the condition of the artery. While under secondary medicinal prophylaxis, the patient experienced two more incidents of basilar artery embolism, all of them requiring endovascular treatment. Further exploration of the dissection revealed a hypertrophic anterior tuberosity of the fifth vertebral body, together with the superior cornu of the thyroid cartilage, impinging and occluding the vertebral artery when the patient’s head was turned to the ipsilateral side, thus indicating so-called bow hunter’s syndrome. Microsurgical resection of the tuberosity and parts of the cornu alleviated the vertebral artery compression under head rotation. The pseudoaneurysm after dissection was further conservatively treated, and the patient did not experience any further strokes in the subsequent period. This chapter describes the rarely diagnosed bow hunter’s syndrome in an unusual constellation with consecutive thrombotic basilar artery occlusion and repeated endovascular thrombectomy in a short time period.