Carotid cavernous fistulas (CCFs) are pathologic connections between the cavernous segment of the carotid artery and the cavernous venous sinus. It involves shunting blood from the internal carotid artery (ICA) and/or the external carotid artery (ECA) to the cavernous sinus (CS) (Hamby, J Neurosurg 21:859–866, 1964). The majority of the clinical signs observed in patients with CCFs are the result of hemodynamic changes in the cavernous sinus leading to increased pressure and engorgement of the draining veins (Korkmazer, World J Radiol 5:143–155, 2013). Treatment options for CCFs have evolved over the years. Starting with ligation of the common carotid artery which subsequently progressed to ICA ligation, more options in CCF ttreatment, have evloved with time. Advancement in neurointerventional technology, more specifically the invention of balloon catheters, has introduced a new era of neuroendovascular treatment modalities of CCFs.