BACKGROUND: Vertebral artery compression by cervical osteophyte is a rare cause 
of vertebrobasilar ischemic stroke. This mechanism of stroke has been reported 
as the Bow Hunter syndrome defined by vertebrobasilar insufficiency because of 
mechanical stenosis of the vertebral artery at the cervical level triggered by 
head movement. The most common treatment is surgical decompression. However, in 
most cases, a dominant vertebral artery is involved, and its dynamic extrinsic 
compression is demonstrated on angiography.
CASE REPORT: We report a patient with recurrent posterior circulation 
infarctions because of the compression of a nondominant vertebral artery by a 
cervical osteophyte. The dynamic angiography did not show any worsening of the 
vertebral stenosis by head movements but an irregularity of the vertebral artery 
with regard to the osteophyte compression, suggesting a direct artery wall 
injury. We concluded to an embolic mechanism through thrombus formation from the 
artery wall injury at the stenosed site. Because neither surgical decompression 
nor stenting was deemed to be a relevant treatment option, endovascular coil 
embolization of the compressed vertebral artery was performed after a clamping 
test to check the efficiency of the collateral circulation. The procedure was a 
success. During the 12-month follow-up, the patient did not have any recurrent 
stroke.
CONCLUSIONS: In case of recurrent symptomatic extrinsic compression of a 
nondominant vertebral artery, endovascular embolization after a clamping test 
may be considered.