Endovascular Trapping of Traumatic

approach to the treatment of traumatic carotid-cavernous fistulas. Four patients with large high-flow shunts have been successfully treated by trapping of the fistula by using a combination of proximal balloon occlusion and distal coil embolization. The latter was achieved following retrograde catheterization of the distal parent vessel via the contralat-eral carotid or ipsilateral vertebral artery. Most direct carotid-cavernous fistulas (CCFs) are caused by trauma to the skull base. Most traumatic CCFs can be treated by transarterial balloon emboli-zation or coil occlusion of the cavernous sinus with preservation of the parent artery, but in a small num-ber of cases this approach is not possible. We describe high-flow CCFs with large venous compartments that could not be managed by conventional endovascular methods. In each instance, the fistula was successfully closed by a combination of proximal balloon occlu-sion and distal trapping by using coils advanced via a retrograde route through either the anterior or pos-terior communicating artery