Endovascular therapy for aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and takotsubo-like cardiomyopathy: A report of ten cases

Abstract

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.

Outcome of endovascular-treated subarachnoid bleeding triggering pulmonary and cardiac Takotsubo

“…about 10 female patients undergoing endovascular treatment for aneurysmal subarachnoid bleeding being complicated by neurogenic pulmonary edema (NPE) and simultaneously Takotsubo syndrome (TTS). [ 1 ] In six patients, the Hunt-Hess classification (HHC) was IV-V and in the remaining patients II-III. [ 1 ] In all patients, embolization was successful without procedure-associated complications.…”

“…[ 1 ] In six patients, the Hunt-Hess classification (HHC) was IV-V and in the remaining patients II-III. [ 1 ] In all patients, embolization was successful without procedure-associated complications. [ 1 ] The outcome on the modified Rankin scale was 0 ( n = 4), 1 ( n = 2), 3 ( n = 1), and 5 ( n = 3).…”

“…[ 1 ] In all patients, embolization was successful without procedure-associated complications. [ 1 ] The outcome on the modified Rankin scale was 0 ( n = 4), 1 ( n = 2), 3 ( n = 1), and 5 ( n = 3). [ 1 ] We have the following comments and concerns.…”

“…[ 1 ] The outcome on the modified Rankin scale was 0 ( n = 4), 1 ( n = 2), 3 ( n = 1), and 5 ( n = 3). [ 1 ] We have the following comments and concerns.…”

“…[ 2 ] Since the outcome is highly variable between these various types, we should know which types of TTS were diagnosed in the ten patients and if the TTS type influenced the outcome. Obviously, the four patients with HHS I-III had the better outcome than the six patients with HHS IV-V.[ 1 ] This finding suggests that HHS rather than severity of TTS or NPE determines the outcome in these patients.…”