title: Spontaneous vertebral arteriovenous fistula causing cervical myelopathy and acute ischemic strokes treated by endovascular balloon-assisted coiling and Onyx embolization.
abstract: Vertebral arteriovenous fistulas (VAVF) are infrequent lesions characterized by abnormal communication of the extracranial vertebral artery or one of its branches to the surrounding venous plexuses, without the presence of any intervening vessels. We describe a rare occurrence of a patient with VAVF presenting with acute ischemic stroke, encephalomalacia from multiple prior embolic events, and cervical myelopathy, which was successfully treated by coil-assisted Onyx embolization (ev3 Endovascular, Plymouth, MN, USA) with balloon for flow arrest. Our patient demonstrates that point occlusion with embolization for VAVF can be a feasible, safe, and effective treatment option for complete obliteration of the fistula, with subsequent reduction in the volume of the intra-spinal canal venous plexus. Although it is postulated that thromboembolism is less common because of redirection of flow to the venous side of the fistula, our patient also illustrates the potential for to-fro flow in such a fistula to result in embolic injury to the distal circulation.
authors: Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, S100-A, Cleveland, OH 44195, USA. Electronic address: johns@ccf.org.
authors: Seby
authors: S
authors: John
authors: Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Neda
authors: N
authors: Jaffari
authors: Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Mei
authors: M
authors: Lu
authors: Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Muhammad S
authors: MS
authors: Hussain
authors: Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Ferdinand
authors: F
authors: Hui
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D021721:Balloon Occlusion / Q000379:methods*; D001807:Blood Vessel Prosthesis; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D013118:Spinal Cord Diseases / Q000209:etiology; D020521:Stroke / Q000209:etiology; D014711:Vertebral Artery / Q000002:abnormalities*
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Cervical myelopathy; Coil-assisted Onyx embolization; Embolic ischemic stroke; Vertebral arteriovenous fistulas