Abstract
The etiology of vertebral arteriovenous fistulas (VAVFs) is diverse, and when selecting an optimal therapeutic strategy, it is important to evaluate the feasibility of preserving the vertebral artery (VA). A 75-year-old woman presented with pulsatile tinnitus, and imaging revealed a high-flow vertebral arteriovenous fistula (VAVF) with a single shunt point at the V2 segment; the distal ipsilateral VA was not visualized, suggesting occlusion or a steal phenomenon. Stepwise balloon adjustment near the shunt site eliminated shunt flow and restored distal VA flow, confirming steal and enabling a successful vessel-preserving treatment. This case demonstrates that controlled modulation of flow near the shunt site using a balloon catheter can effectively predict the potential for restoration of VA flow, and suggests the clinical utility of this technique in planning a strategy that achieves shunt obliteration while preserving the vertebral artery.