Rotational Vertebrobasilar Insufficiency Provoked By Distorted Trajectory of Subclavian Artery

Rotational vertebrobasilar insufficiency (RVBI) is a rare form of decreased posterior brain circulation perfusion and can cause symptoms such as dizziness and vertigo. It is typically caused by unilateral dynamic narrowing of the vertebral artery during rotation of the head. Here we present the case of a 70-year-old male who experienced visual disturbances and syncopal episodes with rotation of his head to the left. Investigation was carried out with fluoroscopic imaging, and his symptoms were treated with vascular surgery. Later we discuss the distinctive characteristics of his imaging and his history which includes distorted vascular architecture and past surgery. The etiology of his RVBI has not been seen in the literature before.