RT Journal Article SR Electronic T1 Direct puncture of the superficial temporal artery for ethylene vinyl alcohol embolization of a type 3 arteriovenous fistula with a dual lumen balloon JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 493 OP 493 DO 10.1136/neurintsurg-2020-016351 VO 13 IS 5 A1 Clarençon, Frédéric A1 Shotar, Eimad A1 Pouvelle, Arnaud A1 Mouyal, Samuel A1 Lenck, Stéphanie A1 Premat, Kevin A1 Cornu, Philippe A1 Sourour, Nader-Antoine YR 2021 UL http://jnis.bmj.com/content/13/5/493.abstract AB Intracranial dural arteriovenous fistulas (dAVFs) may be difficult to treat by endovascular means, especially when the arterial feeders to the fistula are tortuous. 1 The usual main feeder to intracranial dAVFs is the middle meningeal artery, which may present very tight loops that are often difficult to cross with a microcatheter. 2 Direct puncture of a subcutaneous artery feeding the fistula indirectly via transosseous branches may be a valuable strategic option to overcome this limitation. 3 4 We report here the successful embolization of a Cognard type 3 parietal dAVF by direct puncture of the superficial temporal artery under roadmap guidance. The dAVF was subsequently embolized with ethylene vinyl alcohol via a dual lumen balloon, under balloon inflation. We highlight in this technical video 1 the potential difficulties and risks of direct puncture of the superficial temporal artery. We also stress the risk of delayed scalp necrosis using this technique. Video 1.