Fig. 18. A 25-year-old man developed severe right-sided proptosis and a loud bruit at the time of a vehicular accident. Lateral projection of the right internal carotid artery in the early arterial phase (A) and late arterial phase (B) in anteroposterior projection demonstrate immediate opacification of the superior and inferior ophthalmic veins (straight arrows), the inferior petrosal sinuses (curved arrows) and of the deep parenchymal veins of the right hemisphere (open curved arrows). The fistula was related to a large carotid laceration involving the cavernous and supraclinoid segments of the right internal carotid artery. The artery could not be preserved at the time of treatment. C: Latex balloons (open-ended arrowheads) were placed in the fistula and within the carotid artery at the time of treatment. (Courtesy of Frank Huang-Hellinger)