A 59-year-old healthy woman had a cryptogenic stroke that, based on visualization of a significant shunt on transoesophageal echocardiography with contrast bubbles appearing in the left atrium at three beats after filling of the right atrium, was attributed to PFO. However, percutaneous closure of the PFO under local anaesthesia and fluoroscopic guidance failed because no intra-atrial communication was found. Subsequently, cardiac magnetic resonance imaging with angiographic sequences ( Fig. 1 ) showed a single AVM of 4.5 mm in diameter at the level of the right inferior pulmonary artery. By the right femoral vein, using an 8-French multipurpose guiding catheter, we successfully deployed a 6/6 mm Vascular Plug II (AGA, St Jude Medical, Minneapolis, MN, USA) in the AVM. After 15 minutes, no more flow could be seen through the device ( Fig. 2 ). The patient was discharged on aspirin for 6 months with the recommendation for endocarditis prophylaxis for 6 months. At 6-month follow-up, there was no more shunt on transthoracic echocardiography.
