TY - JOUR 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 SP - 493 LP - 493 DO - 10.1136/neurintsurg-2020-016351 VL - 13 IS - 5 AU - Frédéric Clarençon AU - Eimad Shotar AU - Arnaud Pouvelle AU - Samuel Mouyal AU - Stéphanie Lenck AU - Kevin Premat AU - Philippe Cornu AU - Nader-Antoine Sourour Y1 - 2021/05/01 UR - http://jnis.bmj.com/content/13/5/493.abstract N2 - 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. ER -