Early treatment of progressive vertebral arteriovenous fistula caused by cervical penetrating injury

BACKGROUND: Penetrating injury of the vertebral artery (VA) is uncommon because it lies deep in the neck and is surrounded by a bony foramen. Vertebral–venous fistula is a rare vascular condition in which there is direct aberrant communication among the extracranial vertebral artery, its radicular or muscular branches, and adjacent venous structures. CASE PRESENTATION: We report an asymptomatic patient of fistula from the vertebral artery to the paravertebral veins secondary to a cervical stab wound that increased in size and flow, as observed on the angiogram 10 days later, which was successfully treated by endovascular surgery. The postoperative angiogram showed improved visualization of the bilateral posterior cerebral arteries. CONCLUSION: Endovascular embolization at the early phase should be undertaken for traumatic high‐flow vertebral–venous fistula, even if the patient is asymptomatic, to prevent progressive posterior circulation insufficiency due to the rapid growth of the fistula, which can ultimately lead to the steal phenomenon.