{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:02:42Z","timestamp":1790002962989,"version":"4.0.1"},"reference-count":24,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A woman in her 80s was referred for evaluation and treatment of progressive paraparesis due to a suspected spinal arteriovenous shunt. During hospitalisation at the referring institution, she developed multiterritory embolic stroke, prompting investigation.<\/jats:p>\n                  <jats:p>Bilateral deep venous thrombosis and a large pulmonary arteriovenous malformation (PAVM) with a high-grade extracardiac right-to-left shunt were identified, supporting paradoxical embolism as the most likely mechanism. Spinal angiography confirmed a spinal epidural arteriovenous fistula (SEDAVF) with venous drainage into intradural spinal veins and the inferior vena cava.<\/jats:p>\n                  <jats:p>Because liquid embolic material used for SEDAVF treatment could potentially migrate into the inferior vena cava and reach the systemic circulation through the PAVM, a staged approach was adopted. Coil embolisation of the PAVM was performed, followed by N-butyl-2-cyanoacrylate embolisation of the SEDAVF without clinically evident complications.<\/jats:p>\n                  <jats:p>This case highlights the importance of treatment planning based on vascular anatomy and haemodynamics in patients with coexisting arteriovenous shunt lesions.<\/jats:p>","DOI":"10.1136\/bcr-2026-275070","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:16:08Z","timestamp":1790000168000},"page":"e275070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Staged embolisation strategy for spinal epidural arteriovenous fistula with concomitant pulmonary arteriovenous malformation"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8107-4495","authenticated-orcid":false,"given":"Shun","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisayuki","family":"Hosoo","sequence":"additional","affiliation":[{"name":"Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3178-8171","authenticated-orcid":false,"given":"Takeshi","family":"Yoshimoto","sequence":"additional","affiliation":[{"name":"Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Matsumaru","sequence":"additional","affiliation":[{"name":"Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092107151973000_19.9.e275070.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00062-021-01066-6"},{"key":"2026092107151973000_19.9.e275070.2","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1046\/j.1460-9592.1996.d01-14.x","article-title":"Pulmonary embolism following embolization of an arteriovenous malformation","volume":"6","author":"Carapiet","year":"1996","journal-title":"Paediatr Anaesth"},{"key":"2026092107151973000_19.9.e275070.3","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211680"},{"key":"2026092107151973000_19.9.e275070.4","first-page":"19","article-title":"Symptomatic pulmonary complications from liquid acrylate embolization of brain arteriovenous malformations","volume":"16","author":"Pelz","year":"1995","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026092107151973000_19.9.e275070.5","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.019131"},{"key":"2026092107151973000_19.9.e275070.6","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000013169"},{"key":"2026092107151973000_19.9.e275070.7","doi-asserted-by":"crossref","unstructured":"Das A , Greisman JD , Vazquez S , et al . Acute Ischemic Stroke in Patients With Pulmonary Arteriovenous Malformations: Paradoxical Embolism or Epiphenomenon? 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