A minority of traumatic carotido-cavernous fistulas (CCF) are of the indirect variety, and then usually supplied only by meningeal branches of the ipsilateral external carotid artery (Type C). We describe a case of a Type D CCF due to traumatic injury of the inferolateral trunk (ILT), and describe its angiographic features and endovascular management through both the external and internal carotid arteries following a failed transvenous approach.
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