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01-05-2016 | Clinical Article - Vascular

Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy

Authors: Joji Inamasu, Tsukasa Ganaha, Shunsuke Nakae, Tatsuo Ohmi, Akira Wakako, Riki Tanaka, Kiyonori Kuwahara, Hirotaka Kogame, Yushi Kawazoe, Tadashi Kumai, Motoharu Hayakawa, Yuichi Hirose

Published in: Acta Neurochirurgica | Issue 5/2016

Abstract

Background

There are no guidelines regarding the optimal treatment of subarachnoid hemorrhage (SAH) patients complicated by Takotsubo cardiomyopathy (TCM). Although coiling has been favored as the first-line treatment, clipping may also be indicated in patients with ruptured middle cerebral artery aneurysms or in those with massive intracerebral hemorrhage. The study objective is (1) to report the feasibility/safety of clipping/coiling and (2) to identify possible prognosticators in that population.

Methods

Between January 2008 and December 2014, 371 consecutive patients with aneurysmal SAH underwent transthoracic echocardiography after admission, and 30 with TCM (7.7 %) were identified. We reviewed the incidence and type of perioperative complications among clipped (n = 11) and coiled (n = 19) patients. The 30 patients were dichotomized based on their 90-day modified Rankin scale (mRS) scores into favorable (mRS: 0–2) and unfavorable (mRS: 3–6) groups, and their demographic, laboratory and echocardiographic variables were compared.

Results

Neither clipped nor coiled patients developed serious perioperative cardiopulmonary complications, but coiled patients had a higher incidence of fatal procedure-related complications. Among the 30 patients, 13 (43 %) had favorable 90-day outcomes, and the favorable group was significantly younger. Age, but not the degree of cardiac dysfunction, correlated with outcomes by multivariate regression analysis.

Conclusions

Clipping was shown to be a safe treatment modality in our cohort, and treatment selection may better be made on a case-by-case basis in most patients with SAH-induced TCM. The lack of correlation between the degree of cardiac dysfunction and outcomes indicates that aggressive intervention is justified in patients with severely impaired cardiac function.

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Title: Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy
Authors: Joji Inamasu
Tsukasa Ganaha
Shunsuke Nakae
Tatsuo Ohmi
Akira Wakako
Riki Tanaka
Kiyonori Kuwahara
Hirotaka Kogame
Yushi Kawazoe
Tadashi Kumai
Motoharu Hayakawa
Yuichi Hirose
Publication date: 01-05-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-016-2768-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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