Angiographic pitfall: Enlarged artery near pediatric pial AVF may not be a feeder

An enlarged artery adjacent to a pediatric pial arteriovenous fistula (PAVF) may mimic an additional feeder. Superselective angiography showed normal cortical perfusion without early venous drainage, disproving its involvement. Coil embolization of the true fistula preserved the…

• Superselective angiography is essential to differentiate true fistulous feeders from adjacent enlarged but functionally normal arteries in PAVFs, preventing unnecessary embolization of cortical supply.

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