<h3>Patient with repeated ischemic events</h3> During the study, stenosis of both common iliac arteries was identified. so it is diagnosed by radial puncture with complete occlusion of the right internal carotid artery and stenosis of both vertebral arteries. and 70% left internal carotid artery stenosis. and left temporal arteriovenous malformation. and it's programmed for management under general anesthesia. After diagnosis, there was bruising on the right arm. So for treatment, direct carotid puncture is used. with occlusion of arteriovenous temporal malformations with onyx and carotid stenosis management. Shutdown puncture site with angioseal closure device 6fr Successful procedure without complications. Adequate patient evolution without re-detection of ischemic events.