Dong Henry W, Ghahremani Jacob S, Singh Rana S Shamtej, Safran Brent A, Lau David L, Brewer Michael B
Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
Vascular and Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA.
Vasc Endovascular Surg. 2025 Feb;59(2):183-186. doi: 10.1177/15385744241285104. Epub 2024 Sep 13.
Bow Hunter syndrome (BHS) is a rare disorder characterized by mechanical occlusion of the vertebral artery (VA) during neck rotation, resulting in symptomatic, transient, and positional vertebrobasilar insufficiency. We describe a case of a 76-year-old female who presented with dizziness and right ear tinnitus triggered by right head rotation. Her symptoms would immediately resolve upon returning her head to the neutral position. CT angiogram showed 80% stenosis of the left subclavian artery origin, 50%-70% stenosis of the proximal right internal carotid artery (ICA), and near occlusive stenoses of the origins of the bilateral VAs. After failing conservative management, the patient was treated with left subclavian artery stenting, followed by a right carotid endarterectomy (CEA) 6 weeks later. Follow-up at 1 month showed resolution of paroxysmal symptoms and no neurological sequelae. To our knowledge, there have not yet been reported cases of patients with concurrent BHS, subclavian artery stenosis, and carotid artery stenosis. We suggest that global revascularization via subclavian artery stenting and CEA may be considered as treatment for patients with BHS complicated by other cerebrovascular disease secondary to stenoses of the ICA and subclavian artery. This approach obviates the need for more complex surgery or endovascular intervention of the VA.
弓状猎人综合征（BHS）是一种罕见的疾病，其特征是颈部旋转时椎动脉（VA）发生机械性闭塞，导致有症状的、短暂的、体位性椎基底动脉供血不足。我们描述了一例76岁女性病例，该患者因右侧头部旋转引发头晕和右耳鸣。将头部恢复到中立位置后，其症状立即缓解。CT血管造影显示左锁骨下动脉起始部80%狭窄，右侧颈内动脉（ICA）近端50%-70%狭窄，双侧椎动脉起始部近乎闭塞性狭窄。保守治疗失败后，该患者接受了左锁骨下动脉支架置入术，6周后又接受了右侧颈动脉内膜切除术（CEA）。1个月后的随访显示阵发性症状消失，无神经后遗症。据我们所知，尚未有并发BHS、锁骨下动脉狭窄和颈动脉狭窄患者的病例报道。我们建议，对于合并因ICA和锁骨下动脉狭窄继发的其他脑血管疾病的BHS患者，可考虑通过锁骨下动脉支架置入术和CEA进行全面血运重建。这种方法无需对椎动脉进行更复杂的手术或血管内介入治疗。
