A 74-year-old woman with a direct carotid-cavernous fistula secondary to aneurysm rupture was treated by endovascular balloon occlusion of the fistula. Two days later, she suffered an intracerebral hemorrhage ipsilateral to the treated carotid cavernous fistula, perhaps due to normal perfusion pressure breakthrough.
Normal perfusion pressure breakthrough has been described as a cause of hemorrhage following treatment of arteriovenous malformations and carotid stenosis. We report an unusual case of therapeutic endovascular occlusion of a direct carotid-cavernous fistula complicated by hemorrhage presumably caused by normal pressure perfusion breakthrough.
SekhonLHMorganMKSpenceI: Normal perfusion pressure breakthrough: the role of capillaries. J Neurosurg86: 519–524, 1997.
5.
DebrunGMVinuelaF: Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery22: 285–289, 1988.
6.
LewisAITomsickTATewJMJr: Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery36: 239–244, 1995.
7.
HalbachVVHigashidaRT: Normal perfusion pressure breakthrough occurring during treatment of carotid and vertebral fistulas. Am J Neuroradiol8: 751–756, 1987.
8.
NakashimaHTomitaT: A case of atypical course after balloon occlusion for high flow traumatic carotid-cavernous fistula. No To Shinkei47: 177–181, 1995.
9.
KurodaSUshikoshiS: Postoperative hyperperfusion in dural arteriovenous fistula associated with venous ischemia: case report. Surg Neurol49: 406–411, 1998.
