{
  "abstract": "Introduction Extracranial vertebral arteriovenous fistulas (VAVFs) are rare, high-flow lesions that may lead to venous hypertension, osseous remodeling, and spinal cord compression. Management is guided by angioarchitecture and shunt flow dynamics, with particular consideration for the adequacy of posterior circulation collateral supply. We present a high-flow extracranial VAVF managed with deconstructive endovascular therapy after failed venous-side embolization.Methods A 23-year-old woman undergoing imaging for facial swelling was incidentally found to have marked dilation of the left vertebral artery with associated paraspinal venous enlargement and transverse foraminal remodeling. MRI demonstrated ventral cervical cord displacement with subtle T2/STIR hyperintensity at C3-C4. Cerebral angiography identified a direct, high-flow shunt between the proximal V1-V2 segment of the left vertebral artery and the paraspinal venous plexus ( figure 1a) with early venous opacification and distal flow attenuation. Balloon-assisted venous coiling was attempted but was unstable due to extreme shunt flow with persistent coil washout.Results Given robust contralateral vertebral supply and preserved posterior circulation, proximal parent vessel sacrifice was performed with dense coil embolization of the V2 segment, achieving immediate angiographic obliteration of the fistula. Immediate post-procedural imaging demonstrated cross-filling of the distal left vertebral artery from the right vertebral artery without residual shunting. Three-month follow-up angiography confirmed persistent occlusion of the proximal left vertebral artery with distal reconstitution via the deep cervical branch ( figure 1b) and continued right-to-left vertebral cross-filling beyond the coil mass, without evidence of recurrence. The patient remained neurologically intact.Conclusion High-flow extracranial VAVFs require individualized management. When venous-side embolization is unstable and collateral circulation is sufficient, proximal vessel occlusion provides a safe and definitive therapeutic strategy.Disclosures A. Higginbotham: None. D.A. Napoletano: None. G. LeBeau: None. J. Peterson: None.Abstract E-159 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "A Higginbotham"
    },
    {
      "affiliations": [
        "University of Kansas School of Medicine, Kansas City, KS"
      ],
      "name": "DA Napoletano"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "G LeBeau"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "J Peterson"
    }
  ],
  "title": "E-159 Parent vessel sacrifice for vertebral arteriovenous fistula with cervical cord compression",
  "uid": "03496522-6217-5cd3-9e0f-76fa4df00aaf"
}