Bow Hunter's syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and 
is reported to most commonly be caused by vertebral artery impingement on 
cervical vertebrae osteophytes. We report a case in a 56-year-old male patient 
who on investigation of recurrent posterior circulation ischaemic strokes was 
found to have BHS. The aetiology of the syndrome in this patient is due to a 
particularly unusual aberrancy in the path of the atlantoaxial portion of the 
culprit left vertebral artery. Aberrancy of the distal portion of the vertebral 
artery is in itself a rare entity, and there are few reports of it in relation 
to BHS. The patient in this case was successfully treated with endovascular 
sacrifice of the vertebral artery with no further dynamic occlusive symptoms.