Fig. 4.

Penetrating vertebral artery injury with resulting fistula. A 24-year-old man status post gunshot wound to the right skull base (A) with resulting traumatic vertebral arteriovenous fistula. Digital subtraction angiography of the right vertebral artery demonstrates a high-flow fistula between the right vertebral artery V3 segment and perivertebral venous sinuses (B). After coil embolization of the right vertebral artery, there continues to be retrograde flow into the fistula from the left vertebral artery (C). Subsequent retrograde embolization via the left vertebral artery produces complete occlusion of the high-flow fistula (D and E).