Tortuous Artery Research Articles

“Bead to death,” Fibromuscular Dysplasia Presenting as A Rapidly Enlarging Right Anterior Axillary Mass

Fibromuscular dysplasia (FMD) is a rare non-inflammatory, non-atherosclerotic arterial disease characterized by abnormal cellular proliferation and distorted architecture. It commonly affects the renal and extracranial carotid and vertebral arteries, but nearly all arterial beds may be affected, and multivessel involvement is common. We report a rare case of a 31-year-old Filipino female who presented with a rapidly enlarging right anterior axillary mass. Initial consideration was a bleeding soft tissue sarcoma as seen on chest CT scan, while whole abdominal CT scan with IV contrast revealed incidental findings of multiple aneurysms in the superior mesenteric artery, both renal arteries and right common iliac artery, suggestive of fibromuscular dysplasia. Further vascular imaging studies showed a looped left internal carotid, and a tortuous left brachial artery with beading pattern.

Application of Computational Fluid Dynamic Simulation of Parent Blood Flow in the Embolization of Unruptured A1 Aneurysms

To investigate the effect of microcatheter shaping based on the parent artery mainstream line of blood flow simulated using the computational fluid dynamics (CFD) technique on embolization of unruptured aneurysms on the posterior wall of the anterior cerebral artery (ACA) A1 segment. Patients with unruptured cerebral aneurysms on the posterior wall of the ACA A1 segment were retrospectively enrolled and treated with endovascular embolization after microcatheter shaping. The clinical, embolization and follow-up data were analyzed. Eight patients were enrolled and treated with endovascular embolization. Eight microcatheters were steam shaped in vitro and were all successfully navigated to the right location in the in vitro experiment. During the embolization procedure, seven microcatheters were successfully navigated to the right location for embolization. In the remaining one patient who had tortuous cerebral arteries, reshaping of the microcatheter based on the parent artery mainstream of blood flow made successful navigation of the microcatheter to the right place. Complete occlusion was obtained in seven (87.5%) aneurysms and residual aneurysm neck in the remaining one (12.5%). At angiographic follow-up in 6 (75%) patients, the Raymond grade was I in 5 (83.3%) and II in the rest one (16.7%). Use of CFD simulation of parent artery blood flow for microcatheter shaping in the embolization of unruptured aneurysms on the posterior wall of the ACA A1 segment is safe and effective in navigating the microcatheter to the right location for embolization, resulting in good stability and support for the embolization.

Enhancing guidewire efficacy for transradial access: the EAGER randomised controlled trial

Abstract Background and Purpose The standard J tip peripheral guidewire used to perform coronary angiography was originally designed for transfemoral access and large vascular interventions over 70 years ago. The 3mm J tip on the standard wire is larger than the typical radial artery diameter and has limited ability to navigate smaller tortuous peripheral arteries increasing the risk of vessel spasm, and potentially reducing procedural success. We compared the efficacy and safety of a hydrophilic 1.5mm J tip guidewire (intervention - ‘baby J wire’) upfront versus the standard fixed core 0.035" J wire (‘control wire’). Methods Investigator initiated, blinded multicentre randomised trial conducted in Australia. Patients undergoing clinically indicated transradial coronary angiography were randomized 1:1 to either control or baby J peripheral guidewire use upfront. The primary endpoint was technical success defined as gaining access to the aortic root with the randomised guidewire. Secondary endpoints included total procedural time, time to aorta and coronary intubation, crossover rates to alternate wire or access site, fluoroscopy times, radial artery spasm, haematoma (EASY criteria), bleeding complications (BARC criteria) and vascular complications (VARC 2 criteria). Major adverse cardiac events (MACE) and clinical endpoints were adjudicated by a blinded independent clinical events committee. Results 330 patients were enrolled over a 9-month period from October 2022 to June 2023. The median age was 69 years (36% female), BMI 29kg/m2. The primary efficacy endpoint of technical success was achieved more frequently in the intervention group (96% v 85%; ARR 10.9% (95% CI 4.6 -17.2); P <0.001). Women were significantly more likely to benefit from the intervention related to higher failure rates with the control wire (69% vs 93% in men; P = < 0.001). Overall procedure times were similar between the groups (median 1135 vs 1354 seconds; P=0.094) but fluoroscopy time was lower in the baby J wire group (median 344 vs 491 seconds; P = 0.024). Radial completion of procedures was high and did not differ between groups (100% v 98%; P=0.2). Clinically significant bleeding (BARC2+) was more common in the control wire group (3% v 0%; P=0.017). There were no differences in MACE or vascular complications. Conclusion The hydrophilic 1.5mm J tip Baby J peripheral guidewire leads to greater upfront technical success and reduced fluoroscopy time for transradial coronary angiography compared to the standard 3mm J tip guidewire. The baby J hydrophilic guidewire is safe and may have key incremental benefits for the transradial approach particularly in patients with smaller diameter radial arteries including women.Primary Outcome

Essential thrombocythemia complicated by multivessel intracranial dolichoectasia with subarachnoid hemorrhage and recurrent cerebral infarction

BackgroundPatients with essential thrombocythemia (ET) can develop systemic thrombotic and hemorrhagic vascular complications due to increased and dysfunctional platelets.Case presentationWe encountered a 49-year-old Japanese woman with a history of essential ET, cerebral infarction, hypertension, and hyperlipidemia. She had been taking anagrelide (2.5 mg/day) and aspirin (100 mg/day) and had vomited at home. At the time of admission to our hospital, she was in a deep stupor. We thought these symptoms were caused by intracranial hypertension. Head computed tomography showed severe subarachnoid hemorrhage (SAH) at the interhemispheric fissure, hematoma at the corpus callosum, and intraventricular hemorrhages. Digital subtraction angiography demonstrated multiple dilated, stenotic, tortuous intracranial arteries, and a dissecting aneurysm at the right anterior cerebral artery (ACA). The dissecting aneurysm measured 7.7 × 15.5 mm, and a bleb was observed. Our diagnosis was ruptured ACA dissecting aneurysm and diffuse intracranial arterial dolichoectasia (DIADE). We performed stent-assisted coil embolization of the aneurysm. She remained apathetic and manifested unilateral apraxia and alien limb syndrome due to a partial callosal disconnection. Two months thereafter her symptoms gradually improved, her consciousness level and limb function improved, and her modified Rankin scale (mRS) score was 2. However, when we tapered her antiplatelet therapy, she again developed an acute cerebral infarct.ConclusionsThis is the first presentation of a patient with ET complicated by DIADE, both of which can result in ischemic and hemorrhagic vascular complications including SAH. As antithrombotic therapy in patients with DIADE and ET may be associated with higher hemorrhage rates, its effects must be monitored carefully.

First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One+ robotic system

Abstract Background Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain. Case summary We report the first robotic PCI with the R-One+™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year old male patient followed by double drug-eluting stent implantation. Discussion Robotic PCI with the R-One+™ system can not only manage wires, balloons or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.

Transradial Stent Angioplasty Using Double Guide Wires for Severe Stenosis of Vertebral Artery Ostium at a Lower Location

To investigate the effect and safety of transradial stent angioplasty using double guide wires for severe stenosis of vertebral artery ostium at a lower location. Patients with severe stenosis of the vertebral artery ostium at a lower location treated with transradial stent angioplasty were retrospectively enrolled. All the clinical and endovascular treatment data were analyzed. Thirty-nine patients were enrolled. A low location of the vertebral artery ostium was present in 33 (84.6%) patients and an ultra-low location in 6 (15.4%). Transradial stent angioplasty was performed in all patients. In one patient who had a tortuous radial artery, the transradial access was failed. In the other 38 (97.4%) patients, transradial stent angioplasty was all successful. The sharp angle formed between the vertebral artery and the subclavian artery was significantly (P<0.0001) increased from 15°-65° (36°±11°) before to 70-125° (90°±17°) after insertion of a support guide wire. No damage was found in all support guide wires. Thirty-nine stents were deployed, and the preoperative stenosis rate of 70%-98% (85%±13%) was significantly (P<0.0001) decreased to 0-25% (16%) immediately after stenting. Six-12 months after surgery, 29 (74.4% or 29/39) patients were followed up with imaging, and nine (31.0%) patients experienced in-stent restenosis, with endovascular retreatment being performed in 3 (33.3%) patients. Transradial stent angioplasty using double guide wires is safe and effective for the treatment of severe stenosis of the vertebral artery ostium at a lower location even though more studies are necessary to confirm this.

Comparative Efficacy and Safety of Self-Expandable vs. Balloon-Expandable Stent Grafts in Visceral Artery Aneurysm Management.

This study assesses the efficacy and safety of self-expandable (SE) versus balloon-expandable (BE) stent grafts for managing visceral artery aneurysms (VAAs), focusing on procedural success and complication rates. We conducted a retrospective analysis of VAA patients treated at our institution from April 2006 to September 2021. The study reviewed patient demographics, aneurysm characteristics, treatment details, and outcomes, including endoleaks. Among the 23 patients analyzed, splenic artery aneurysms represented 44% of cases. Fifteen patients were treated with balloon-expandable stent grafts (BE SGs), and eight patients were treated with self-expandable stent grafts (SE SGs). For saccular aneurysms, the average neck size was 10.10 ± 8.70 mm in the BE group versus 18.50 ± 3.40 mm in the SE group (p = 0.23), with an average sac size of 20.10 ± 18.9 mm in the BE group versus 15.60 ± 12.7 mm in the SE group (p = 0.16). The average sac-to-neck ratio was 1.69 ± 2.23 in the BE group versus 1.38 ± 0.33 in the SE group (p = 0.63). The BE group exhibited a significantly higher endoleak rate (60%) compared to the SE group (12.5%; p = 0.03). While further investigation is needed to fully assess the outcomes of stent graft treatment for VAAs, initial data show a significantly higher endoleak rate with BE SGs compared to SE SGs. The SE SGs may offer better outcomes due to their superior ability to conform to tortuous and mobile visceral arteries.

Association between cervicocerebral artery dissection and tortuosity - a review on quantitative and qualitative assessment.

Cervicocerebral artery dissection stands out as a significant contributor to ischemic stroke in young adults. Several studies have shown that arterial tortuosity is associated with dissection. We searched Pubmed and Embase to identify studies on the association between arterial tortuosity and cervicocerebral artery dissection, and to perform a review on the epidemiology of cervicocerebral artery tortuosity and dissection, pathophysiology, measurement of vessels tortuosity, strength of association between tortuosity and dissection, clinical manifestation and management strategies. The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation is used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervicocerebral artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with cervicocerebral artery dissection. Symptomatic patients with extracranial cervical artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Patients with recurrent ischemia, compromised cerebral blood flow or contraindications for antithrombotic agents are usually treated with open surgery or endovascular technique. Those with subarachnoid hemorrhage and intracranial artery dissection are often managed with surgical intervention due to high risk of re-hemorrhage.

Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

South African flag sign: A Red Flag in ECG

A method is developed to allow cardiologists to find changes in the blood flow rate in larger coronary arteries, caused by the appearance of their pathological tortuosity, and a hemodynamic significance of those changes based on the data taken from the appropriate coronarographies only. This method is based on replacement of blood flows in the originally healthy and subsequently pathologically tortuous artery with the corresponding averaged ones, and subsequent calculation of flow characteristics of interest in terms of the corresponding averaged flow characteristics. It allows one not to take account of a number of identical factors for the originally healthy and subsequently pathologically tortuous segment of the investigated artery, and gives one the possibility to determine the flow parameters of concern at any time after carrying out a coronarography. In addition, it is not associated with solving complicated technical problems, and does not require special facility to be used, special professional training and significant financial and temporal expenses. The method was successfully tested in-vitro and then applied to appropriate patients. It was found that the hemodynamic significance of the tortuosity generally increases/decreases as the number of the tortuosity arcs increases/decreases. Also, strong correlation between fundamental geometric and hemodynamic characteristics of the tortuosity and basic clinical indicators of the corresponding patients was established. This suggests a strong independent influence of the tortuosity on the clinical symptoms of the corresponding patients. The critical values for the number of the tortuosity arcs, the relative blood flow rate loss and the rate of angina.

C-12 | Acurracy of iFR in Tortuous Coronary Arteries

C-12 | Acurracy of iFR in Tortuous Coronary Arteries

Coronary artery calcification: concepts and clinical applications.

Vascular calcification is an important hallmark of atherosclerosis. Coronary artery calcification (CAC) implies the presence of coronary artery disease (CAD), irrespective of risk factors or symptoms, is concomitant with the development of advanced atherosclerosis. Coronary thrombosis is the most common clinical end event leading to acute coronary syndrome (ACS). The least common type of pathology associated with thrombosis is the calcified nodule (CN). It usually occurs in elderly patients with severely calcified and tortuous arteries. The prevalence of calcified nodules in patients with ACS may be underestimated due to the lack of easily recognisable diagnostic methods. In this review, the authors will focus on the classification, clinical significance, pathogenesis, and diagnostic evaluation and treatment of CAC to further explore the clinical significance of CN.

A case of vertebrobasilar dolichoectasia manifesting as sudden sensorineural hearing loss with vertigo

Vertebrobasilar dolichoectasia (VBD) is a rare vascular condition characterized by the elongation, widening, and tortuosity of the vertebrobasilar artery. It can lead to various symptoms due to compression of cranial nerves and brainstem structures. We report a rare case of VBD presenting as sudden sensorineural hearing loss (SSNHL) with vertigo and spontaneous downbeat nystagmus in a 65-year-old woman with a history of hypertension. Magnetic resonance imaging revealed a tortuous and dilated right vertebrobasilar artery compressing the brainstem and left 8th cranial nerve root entry zone, without signs of acute cerebellar stroke. The compression of the anterior inferior cerebellar artery and cervicomedullary junction was also noted, suggesting a vascular cause for her symptoms. Following high-dose steroid treatment, the patient showed significant hearing improvement. This case underscores the importance of considering VBD in patients with unexplained SSNHL and vertigo, highlighting the role of detailed vascular imaging in the diagnosis and management of such cases.

Novel Strategies for the Hostile Iliac Artery during Endovascular Aortic Aneurysm Repair.

Successful endovascular aneurysm repair can be achieved with favorable aortic and iliac arterial anatomies. However, patients with challenging iliac anatomy, such as stenotic, calcified, tortuous arteries, or concomitant iliac artery aneurysms, are commonly encountered. Such a hostile iliac anatomy increases the risk of intraprocedural complications and worsens long-term outcomes. This review addresses various technical options for treating patients with a hostile iliac anatomy, including innovative endovascular solutions, physician-modified endografts, and hybrid procedures. These considerations demonstrate the wide scope of therapies that may be offered to patients with an unfavorable iliac anatomy.

An Improved Path-Finding Method for the Tracking of Centerlines of Tortuous Internal Carotid Arteries in MR Angiography.

Centerline tracking is useful in performing segmental analysis of vessel tortuosity in angiography data. However, a highly tortuous) artery can produce multiple centerlines due to over-segmentation of the artery, resulting in inaccurate path-finding results when using the shortest path-finding algorithm. In this study, the internal carotid arteries (ICAs) from three-dimensional (3D) time-of-flight magnetic resonance angiography (TOF MRA) data were used to demonstrate the effectiveness of a new path-finding method. The method is based on a series of depth-first searches (DFSs) with randomly different orders of neighborhood searches and produces an appropriate path connecting the two endpoints in the ICAs. It was compared with three existing methods which were (a) DFS with a sequential order of neighborhood search, (b) Dijkstra algorithm, and (c) A* algorithm. The path-finding accuracy was evaluated by counting the number of successful paths. The method resulted in an accuracy of 95.8%, outperforming the three existing methods. In conclusion, the proposed method has been shown to be more suitable as a path-finding procedure than the existing methods, particularly in cases where there is more than one centerline resulting from over-segmentation of a highly tortuous artery.

Abstract TP201: Impact of Microguide Wire Stiffness on Microcatheter and Aspiration Catheter Navigation in Tortuous Vessels

Background and Purpose: Endovascular therapies require devices to access treatment sites safely and efficiently. Vessel tortuosity often complicates this navigation, increasing the risk of microguide wire (MGW) or microcatheter (MC) kickback, which may result in unstable device movements or sudden drop of devices. This study aims to elucidate the effect of MGW stiffness variability on the trackability of MC and aspiration catheters (AC). Methods: Using two silicone vascular models, we replicated the M2 segment of the middle cerebral artery (MCA) at an 80-degree branch (MCA model, Fig. A) and a severely tortuous internal carotid artery (ICA model, Fig. B). Experiments were conducted under conditions of 37°C, 60 BPM, and an ICA flow rate of 240 mL/min. In the MCA model, the MC (TrevoTrak21) was advanced from the M1 segment to distal M2 while three MGWs (Synchro SELECT Soft, Standard, Support) were placed at distal M2. In the ICA model, the AC (Zoom 71) was advanced from ICA to M1 with MC and MGW at distal M2. Maximum push force and kickback length were measured while TrevoTrack21 or Zoom71 were advanced at 4 mm/sec for 7 runs per device. One-way ANOVA assessed group differences. Results: In the MCA model, when using the Soft MGW, the MC recorded the highest pushing force at 59.3mN and kickback of 29.87mm. Conversely, the Support MGW demonstrated the least pushing force at 38.2mN (P&lt;0.001) and the shortest kickback length at 17.83mm (P&lt;0.001). For the ICA model, differences in forces across the MGW types were less distinct. However, the kickback length with the Soft MGW at 13.78mm was significantly greater than that with the Standard MGW at 6.26mm and the Support MGW at 6.76mm (P=0.026). Conclusion: Our findings suggest that MGWs with higher stiffness offer more stable guidance, requiring less force in both MC and AC navigation. Moreover, increased MGW stiffness consistently leads to shorter kickback lengths, emphasizing its importance in stable device navigation.

Ultra-Widefield Imaging of the Retinal Macrovasculature in Parkinson Disease Versus Controls With Normal Cognition Using Alpha-Shapes Analysis.

To investigate retinal vascular characteristics using ultra-widefield (UWF) scanning laser ophthalmoscopy in Parkinson disease (PD). Individuals with an expert-confirmed clinical diagnosis of PD and controls with normal cognition without PD underwent Optos California UWF imaging. Patients with diabetes, uncontrolled hypertension, glaucoma, dementia, other movement disorders, or known retinal or optic nerve pathology were excluded. Images were analyzed using Vasculature Assessment and Measurement Platform for Images of the Retina (VAMPIRE-UWF) software, which describes retinal vessel width gradient and tortuosity, provides vascular network fractal dimensions, and conducts alpha-shape analysis to further characterize vascular morphology (complexity, Opαmin; spread, OpA). In the PD cohort, 53 eyes of 38 subjects were assessed; in the control cohort, 51 eyes of 33 subjects were assessed. Eyes with PD had more tortuous retinal arteries in the superotemporal quadrant (P = 0.043). In eyes with PD, alpha-shape analysis revealed decreased OpA, indicating less retinal vasculature spread compared to controls (P = 0.032). Opαmin was decreased in PD (P = 0.044), suggesting increased vascular network complexity. No differences were observed in fractal dimension in any region of interest. This pilot study suggests that retinal vasculature assessment on UWF images using alpha-shape analysis reveals differences in retinal vascular network spread and complexity in PD and may be a more sensitive metric compared to fractal dimension. Retinal vasculature assessment using these novel methods may be useful in understanding ocular manifestations of PD and the development of retinal biomarkers.

Role of a Tortuous Vertebrobasilar Artery and Anchoring Perforators in the Etiology of Hemifacial Spasm

In >70% of patients with hemifacial spasm (HFS), the offending artery is either the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA), without a tortuous vertebrobasilar artery (VBA). We hypothesized that anchoring perforators around the root exit zone (REZ) of the AICA or PICA might induce vascular deviation and compression. We investigated the occurrence of these perforators from the AICA or PICA and the extent of VBA tortuosity to reveal the pathology of vascular compression. This retrospective review included 110 patients after excluding those with vertebral artery (VA) compression alone. The occurrence of perforators was determined according to operative findings within 5 mm of the REZ, and VBA tortuosity was evaluated using MATLAB. We analyzed the association between perforators, VBA tortuosity, and the surgical implications. The occurrence of perforators from the offending AICA or PICA around the REZ was significantly higher in the group without VA compression (Group A) than in the group with VA compression (Group B). VBA tortuosity was significantly lower in Group A. VBA tortuosity was inversely correlated with the presence of AICA or PICA perforators in all 110 patients. Operative results were similar between the groups, although patients with low VBA tortuosity tended to require interposition in decompression procedures. Anchoring perforators around the REZ play a crucial role in vascular compression for patients with less tortuous VBAs. Moreover, surgeons should be prepared to deal with multiple perforators in a more complicated surgery in cases of less tortuous VBA.

Wandering Spleen in Operated Case of Congenital Diaphragmatic Hernia

Wandering spleen (WS) is a rare condition characterized by abnormal mobility of the spleen due to laxity or absence of its supporting ligaments. We report an exceptional case of WS in a pediatric patient who had previously undergone surgical repair for congenital diaphragmatic hernia (CDH). A 16-year-old male, with a history of CDH repair in infancy, presented with a two-day history of abdominal pain and vomiting. Clinical examination revealed abdominal distension, tenderness, and sluggish bowel sounds. Imaging studies, including a contrast-enhanced computed tomography (CECT) scan, indicated small bowel obstruction due to an internal hernia, potentially involving the foramen of Winslow. Intriguingly, the patient's spleen had migrated to the left iliac fossa, accompanied by partial thrombosis of the splenic vein. Surgical intervention was deemed necessary. During exploratory laparotomy, the patient was found to have a reversed anatomy, with the ascending colon, cecum, and appendix on the left side, and the small bowel on the right side. Additionally, a WS was discovered with a long and tortuous splenic vein and artery. Surgical procedures included adhesiolysis, primary closure of serosal tears, splenopexy for spleen repositioning, and bowel derotation. The patient's postoperative recovery was uneventful, and he was monitored closely to ensure the resolution of the complications associated with this unique presentation.

Use of Polyurethane-Covered Stents for Exclusion of Pulmonary Arteriovenous Malformations.

To evaluate the safety, technical success and short-term effectiveness of polyurethane-covered stent (PK Papyrus, BioTronik, Berlin) in the treatment of pulmonary arteriovenous malformations (PAVMs) that are not amenable to embolotherapy. In this IRB-approved, retrospective study, data from patients who received polyurethane-covered stents for exclusion of PAVMs were analyzed. The study included 5 patients (all women) with a median age of 40years (range 25-60). Patients presented with hypoxemia, TIAs, and/or epistaxis; 4 were confirmed to have HHT. All had multiple PAVMs diagnosed on chest CT and underwent embolization with other devices in addition to the polyurethane-covered stent. The indication for stent placement in all cases was a short and/or tortuous feeding artery. Safety was assessed by immediate or short-term complications, e.g., migration, stent thrombosis, and fracture. Technical success was defined as the ability to accurately place the stent at the intended location. Effectiveness was defined as successful exclusion of PAVM with no perfusion across the AVM. Technical success of stent placement was 100%. AVM exclusion rate was 80% after single stent deployment; in the case of incomplete exclusion, success was achieved using an overlapping stent to completely cover a second feeding artery. During the median follow-up period of 5months (range 2-10), all stents remained patent, and AVMs were excluded without other complications. Exclusion of PAVMs with polyurethane-covered stents is technically feasible, safe, and shows short-term effectiveness for PAVMs with a short/tortuous feeding artery when traditional embolization techniques are not possible.