PMC3115199_01
(a) Left VA angiogram showing an AVF draining into bilateral internal jugular veins and diffuse fibromuscular dyspastic change; (b) Right VA injection showing retrograde filling of the distal left VA into the right VA-jugular vein fistula, and diffuse fibromuscular dysplastic change; (c) after deployment of the stent-graft showing complete occlusion of the AVF with normalization of the antegrade flow within the intracranial portion of the left VA; (d) Right VA injection showing no cross flow of contrast into the left intracranial VA; (e) 3 D-imaging from a Q-MRA, showing reconstitution of the left VA with no opacification of the fistula; (f) Q-MRA flow maps indicating 151 ml / minute of antegrade blood flow within the left VA compared to 744 ml / minute at the baseline
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F1
Cerebral angiography demonstrated a large, high-flow AVF originating from the left vertebral artery (VA) and draining into the internal jugular veins bilaterally [Figure 1a]. Retrograde flow from the right VA also supplied the fistula [Figure 1b]. Control angiography of the left VA demonstrated complete closure of the fistula with preservation of flow to the intracranial circulation [Figure 1c], and reversal of the contralateral flow from the right VA [Figure 1d]. Post procedural Q-MRA demonstrated normalization of the antegrade flow through the left VA distal to the fistula at 143 ml / minute, with a combined total of 261 ml / minute within both vertebral arteries, (the normal range of combined vertebral flow was 99 - 281 mg / minute) [Figures 1e and f].
PMC3115199_02
(a) Left CCA angiogram showing a pseudoaneurysm at the carotid bifurcation; (b) exclusion of the pseudoaneurysm after deployment of the covered stent
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F2
Angiography demonstrated left common carotid artery (CCA) blowout with a pseudoaneurysm at the carotid bifurcation [Figure 2a]. Control angiography showed complete exclusion of the pseudoaneurysm as well as the external carotid artery [Figure 2b].
PMC3115199_03