Objective To retrospectively study clinical features and diagnostic imaging of vasculogeneic pulsatile tin-nitus, and the feasibility and efficacy of transvascular interventional treatment for this condition. Methods Data from 82 cases of arterial or venous pulsatile tinnitus were reviewed. DSA characteristics and possible pathophysiological mechanisms of pulsatile tinnitus in these cases were studied. Diagnoses in this group in-cluded intracranial arterovenous fistula (AVF) (n=3), spontaneous skull base dural AVF (n=16), traumatic ca-rotid-cavernous sinus fistula (n=5), subclavian artery stenosis (n=2), internal carotid artery stenosis (n=3), in-tracranial arterial stenosis (n=1), kinked and/or elongated vertebrobasilar artery (n=2), venous sinus divertic-ulum (n=2), venous sinus stenosis on the dominant drainage side (n=46) and occipital sinus stenosis (n=2). Treatments included embolization and stenting using coils, NBCA glue, Balt balloons, self-expansion stents and intracranial micro-stents via either the femoral artery or femoral vein. Results Procedures were suc-cessful in all cases with no surgery-related complications. Tinnitus disappeared within 2 days after the pro-cedure in all cases. Follow up duration was 5-36 months. Recurrence occurred in 4 cases of arterial tinnitus within 3 months following the initial procedure, which improved after revision embolization or symptom management. There was no recurrence in venous tinnitus cases following stent plastic or stent-coiling embo-lization treatments. Conclusions Endovascular intervention provides a new approach to the diagnosis and treatment of intractable pulsatile tinnitus. It is also effective in differentiating and studying other types of tinnitus.