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Objective: Multiple endovascular management of the direct CCF have been widely accepted as therapeutic option.Embolization of the fistula with detachable balloons or thrombogenic coil-based occlusion was the main choice to treat the direct CCF with good safety and efficacy.This study investigated the safety and efficacy of embolization of direct CCF with the novel double-balloon technique.Methods: A retrospective review of a prospective database on cerebral vascular disease was performed.We identified a total of five patients presenting with the high-flow direct CCF.All patients were managed with transarterial embolization with the novel double-balloon technique.Results: Three of the 5 patients using the double-balloon technique were treated with two detachable balloons and completely occluded fistula with preservation of the ICA.In the remaining patient treated with more detachable balloons, one patient got perfect outcomes and another suffered from recurrent fistula attributed to balloon migration 3 weeks after embolization.During a follow-up of 12-18 months, no recurrence of the symptoms in any patient.Conclusions: The novel double-balloon technique for transarterial treatment of CCFs is a feasible method that increases the probability to completely occlude the CCF.This technique is markedly beneficial both when a single inflated detachable balloon is unable to completely occlude the CCF which causes the next balloon fail to pass into the fistula, and several balloons are required to embolize the large CCF.