Key result
Impella 5.5 deployment enables full myocardial and neurological recovery in refractory Takotsubo cardiogenic shock.
Why the study?
Aneurysmal subarachnoid hemorrhage is complicated by Takotsubo syndrome in 15% to 25% of patients, and when this leads to refractory cardiogenic shock, it represents a challenging complication with limited published guidance.
Case Report (n=1)
No
Microaxial flow pump rescue appears to be a viable strategy for refractory cardiogenic shock from Takotsubo syndrome complicating high-grade aneurysmal subarachnoid hemorrhage, even during dual-antiplatelet therapy.
Answers are grounded in this paper and cite their sources.
Case experience suggests mechanical circulatory support as an option for refractory shock in Takotsubo syndrome post-aSAH; hypothesis-generating and should not yet change practice.
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is complicated by Takotsubo syndrome (TTS) in 15% to 25% of patients. Managed with supportive care, TTS with refractory cardiogenic shock represents a challenging complication with limited published guidance. CASE SUMMARY: A 78-year-old woman presented with high-grade aSAH requiring external ventricular drain placement, stent-assisted aneurysm coiling, and dual antiplatelet therapy complicated by TTS and cardiogenic shock refractory to pressors and inotropes. A microaxial flow pump (Impella 5.5) was deployed, with full myocardial and neurological recovery. DISCUSSION: Often self-limiting but causing secondary injury, TTS secondary to neurologic injury is driven by catecholamine-mediated myocardial injury. Mechanical circulatory support has been reported for TTS and refractory cardiogenic shock. After conducting a literature review, we believe this is the first reported use of an Impella 5.5 for refractory cardiogenic shock from TTS secondary to subarachnoid hemorrhage. TAKE-HOME MESSAGE: Microaxial flow pump rescue appears to be a viable strategy for refractory cardiogenic shock complicating high-grade aSAH, even during dual-antiplatelet therapy.
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Puissant et al. (2026) conducted a case report in High-grade aneurysmal subarachnoid hemorrhage complicated by Takotsubo syndrome and refractory cardiogenic shock (n=1). Microaxial flow pump (Impella 5.5) was evaluated on Myocardial and neurological recovery. Microaxial flow pump (Impella 5.5) deployment achieved full myocardial and neurological recovery in a 78-year-old woman with high-grade aSAH and refractory cardiogenic shock from Takotsubo syndrome.
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