Key result
Endovascular therapy resulted in a favorable clinical outcome (Modified Rankin Scale score 0-3) at 6 months in 70% of patients with aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy.
Why the study?
Aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy carries dismal outcomes, and the efficacy of endovascular therapy in this setting needed validation.
Does endovascular therapy improve clinical outcomes in patients with aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy?
Case Report (n=10)
No
Does endovascular therapy improve clinical outcomes in patients with aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy?
Endovascular coil embolization is a feasible and safe alternative treatment for patients with high-grade aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy.
Supports feasibility of endovascular embolization in high-grade aSAH with NPE/TCM; hypothesis-generating, needs prospective validation before practice change.
OBJECTIVE: Patients sustaining aneurysmal subarachnoid hemorrhage (aSAH) can be further complicated by neurogenic pulmonary edema (NPE) and Takotsubo-like cardiomyopathy (TCM) with dismal outcomes. The present study aimed to validate the efficacy of endovascular therapy for patients with aSAH complicated by NPE and TCM. MATERIALS AND METHODS: Patients who were diagnosed with aSAH complicated by NPE and TCM and treated by endovascular therapy were retrospectively evaluated. RESULTS: In the past 5 years, a total of ten female patients with aSAH were also diagnosed with NPE and TCM. Six of the ten were cases with high-grade aSAH (Hunt and Hess Grades IV and V), whereas four were low-grade aSAH (Grades II and III). The locations of ruptured aneurysms were the internal carotid-posterior communicating artery junctional site in five patients, the anterior communicating artery in two, the vertebral artery in two, and the middle cerebral artery in one. These aneurysms were successfully embolized by endovascular therapy without any procedure-associated complications. The clinical outcome measure at 6 months after discharge on the Modified Rankin Scale was found to be 0 in four patients, 1 in two, 3 in one, and 5 in three. CONCLUSIONS: Endovascular therapy can be a feasible, alternative measure for the treatment of patients with high-grade aSAH who also have NPE and TCM.
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Nonaka et al. (2020) conducted a case report in Aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy (n=10). Endovascular therapy was evaluated on Favorable clinical outcome (Modified Rankin Scale score 0-3) at 6 months after discharge. Endovascular therapy resulted in a favorable clinical outcome (Modified Rankin Scale score 0-3) at 6 months in 70% of patients with aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy.
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