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

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

研究成果: ジャーナルへの寄稿総説査読

15 被引用数 (Scopus)


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.

ジャーナルActa Neurochirurgica
出版ステータス出版済み - 01-05-2016

All Science Journal Classification (ASJC) codes

  • 外科
  • 臨床神経学


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