Rotational vertebral artery occlusion (RVAO) is a well-documented surgically amenable
cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using
dynamic rotational angiography. We report a case of RVAO in which intraoperative indocyanine
green angiography (ICGA) was used to confirm adequate surgical decompression of the
VA. A 57-year-old female who presented with multiple episodes of syncope provoked
by turning her head to the right. Rotational dynamic angiography revealed a dominant
right VA that became occluded at the level of C5/6 with head rotation to the right.
The patient underwent successful surgical decompression of the VA via an anterior
cervical approach. ICGA demonstrated VA patency with head rotation. This was further
confirmed by intraoperative dynamic catheter angiography. To the best of our knowledge,
we present the first use of ICG combined with intra-operative dynamic rotational angiography
to document the adequacy surgical decompression of the VA in a patient with RVAO.
Key-words:
Bow Hunter's syndrome - dynamic angiography - indocyanine green video angiography
- rotation vertebral artery occlusion - vertebral artery
