Occipital-vertebral anastomosis (O-V anastomosis) is a common collateral anastomosis between the external carotid and the vertebro-basilar system. But symptomatic O-V anastomosis is rare. We report a case with syncope and vertebrobasilar insufficiency caused by O-V anastomosis. It was thought that the vertebral steal phenomenon through this anastomotic channel caused these symptoms.
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