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Rotational carotid insufficiency: an unusual cause of bow hunter’s syndrome
  1. Peter Kan1,
  2. Aditya Srivatsan1,
  3. Jeremiah N Johnnson1,
  4. Stephen R Chen2
  1. 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Peter Kan, peter.kan{at}


We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter’s-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable.

  • stent
  • neck
  • intervention
  • blood flow
  • artery

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  • Contributors PK: Study concept, manuscript writing and revision. AS: Manuscript writing and revision. JNJ: Manuscript writing and revision. SRC: Study concept, manuscript writing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.