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In this case the vertebral artery coursed under rather than over the posterior arch of the C-1. This patient was also found to have incomplete development of the posterior arch of C-1, as is often seen with this variant. The patient underwent dynamic digital subtraction angiography, which demonstrated occlusion at the variant vertebral artery with head turning. He was then taken for decompression of the vertebral artery through removal of the incomplete arch of C-1 that was causing the dynamic compression. After surgery the patient had a complete resolution of symptoms. In this report, the authors present the details of this case, describe the anatomical variants involved, and provide a discussion regarding the need for atlantoaxial fusion in these patients.<\/jats:p>","DOI":"10.3171\/2016.7.spine163","type":"journal-article","created":{"date-parts":[[2016,10,7]],"date-time":"2016-10-07T14:01:36Z","timestamp":1475848896000},"page":"199-202","source":"Crossref","is-referenced-by-count":20,"title":["Rotational vertebrobasilar insufficiency due to compression of a persistent first intersegmental vertebral artery variant: case report"],"prefix":"10.3171","volume":"26","author":[{"given":"Vivek P.","family":"Buch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Madsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry A.","family":"Vaughan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F.","family":"Koch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.","family":"Kung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine163","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"908.e1","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.09.006","article-title":"Vertebral artery stenting for the treatment of bow hunter's syndrome: report of 4 cases.","volume":"21","author":"Darkhabani MZ,","year":"2012","unstructured":"Darkhabani MZ, Thompson MC, Lazzaro MA, Taqi MA, Zaidat OO: Vertebral artery stenting for the treatment of bow hunter's syndrome: report of 4 cases.. 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