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Abstract Details

Multiple watershed infarcts confirming the existence of a vascular steal phenomenon established around a brain arteriovenous malformation
Cerebrovascular Disease and Interventional Neurology
P13 - Poster Session 13 (5:30 PM-6:30 PM)
4-020
To present a clinical case that proves the existence of an arteriovenous malformation (AVM) vascular steal phenomenon (VSP).
AVMs are abnormalities of intracranial vessels constituting a connection between the arterial and venous systems without an intervening capillary bed. Most common presenting symptoms are hemorrhage and seizures. Focal neurologic deficits occur in 1-40% of patients and are deemed to be related with VSP and/or venous hypertension. The VSP has been proposed to be centered around the AVM nidus and results from the high-flow arteriovenous shunting through low resistance fistulae; causing a reduction of blood pressure in the feeding arteries lowering the cerebral blood flow in the surrounding brain tissue.
A 66-year-old man with a 3-day history of right eye blurriness. Brain MRI showed acute watershed infarcts along the left ACA/MCA and left MCA/PCA territories. An angiogram revealed a left temporoparietal AVM with small feeding arteries from the left M2 segment and multiple superficial cortical draining veins. Also, a moderate stenosis of the distal left M1 segment and a mild stenosis of the distal left P1 segment were observed. 
N/A
We hypothesize that the watershed infarcts give proof of the VSP aggravated by the MCA M1 and PCA P1 stenotic lesions also present in this patient. Although the VSP has been challenged by some authors in the past, it is understood that the small size of adjacent unaffected arteries compared to the large size of feeding AVM arteries, as well as the rapid flow established through the shunt, propitiates a perilesional blood flow reduction that affects primarily the surrounding brain parenchyma. In this case, we believe that the steal phenomenon surrounding the AVM reduced the already compromised flow provided by the stenotic left MCA and left PCA, leading to the occurrence of watershed infarcts.
Authors/Disclosures
Gabriel Torrealba Acosta, MD (Duke University Medical Center)
PRESENTER 		Dr. Torrealba Acosta has nothing to disclose.
No disclosure on file
Cesar Escamilla Ocanas Mr. Escamilla Ocanas has nothing to disclose.
Rahul Damani Rahul Damani has nothing to disclose.