Developmental venous anomaly coexisting with a true arteriovenous malformation: a rare clinical entity.

Two patients diagnosed with arteriovenous malformation (AVM) in close association with a developmental venous anomaly (DVA) are reported. The first patient presented with episodes of left extremity weakness and numbness as well as chronic headaches. The second patient presented with spontaneous intracerebral hemorrhage. Cerebral angiography showed that both the AVM and the transmedullary veins of the DVA drained through the transcortical vein. The AVMs were treated by highly selective transarterial embolization with Onyx embolic agent while preserving the DVAs. It is suggested that the cause of the presentation in both patients was secondary to the association of the AVM with the delicate hemodynamic balance and less robust angioarchitecture of the DVA.

Endovascular management of symptomatic vertebral artery origin stenosis in the presence of an acute thrombus.

A woman in her early 60s with hypertension and hyperlipidemia was undergoing investigations for anemia of unknown etiology. She developed a sudden reduction in visual acuity and bilateral visual field impairment. MRI and angiography revealed acute infarcts in the posterior circulation and severe narrowing of the left vertebral artery origin. Digital subtraction angiography demonstrated a high-grade stenosis of the left vertebral artery origin with a thrombus just distal to the stenosis. The patient developed recurrent infarcts while on antithrombotic therapy. The lesion was successfully treated by vertebral artery origin angioplasty and stenting (VOAS) using a flow reversal technique and distal embolic protection. She was discharged to a rehabilitation facility 4 days later without worsening or new neurological deficits. A search of the literature yielded a similar report managed with anticoagulation and subsequent VOAS after complete lysis of the thrombus. Our report highlights the technique, safety and feasibility of VOAS in the presence of a thrombus using a flow reversal technique and distal protection.