Abstract
High flow spontaneous vertebral arteriovenous shunts in patients with fibromuscular dysplasia (FMD) are rare. We present a 59-year-old woman with progressive dizziness, pre-syncopal episodes and tinnitus. Catheter-based angiography identified features of FMD and a high flow, right cervical vertebral artery arteriovenous shunt. Onyx-18 embolization (Onyx liquid embolic system, eV3, Irvine, CA, USA) of the principal draining veins was performed with initial detachable coil placement. Complete disconnection of the shunt was achieved without sacrifice of the parent vertebral artery. Thus, spontaneous high flow vertebral arteriovenous shunts can be successfully occluded with Onyx/detachable coil embolization of the principal recipient veins. To our knowledge, this is the first report of Onyx embolization of the recipient veins with shunt disconnection and preservation of the affected vertebral artery in a patient with FMD.
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