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Persistent primitive trigeminal artery (PPTA) is the most common type of fetal carotid-basilar persisting communication in adulthood; however, carotid-cavernous fistulas (CCFs) associated with PPTA are rare. An 84-year-old woman presented with traumatic CCF associated with PPTA manifesting as vascular bruit. Transarterial embolization was performed. Although a detachable coil was deployed at the fistula point, it was easy to migrate into the cavernous sinus because of the high-flow shunt. Therefore, a stent was deployed in the PPTA, and the inner lumen of the stent with a focus on the fistula point was occluded by using coils. Subsequently, the CCF completely disappeared. In-stent coil embolization was effective and reasonable for the high-flow CCF associated with the PPTA. This method reduced the number of coils required and operating time. However, careful preservation of perforators is needed. [ABSTRACT FROM AUTHOR]