title: Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy.
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.
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan. inamasu@fujita-hu.ac.jp.
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ganaha
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakae
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohmi
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Wakako
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Riki
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kuwahara
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kogame
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Kawazoe
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kumai
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D013525:Surgical Instruments; D054549:Takotsubo Cardiomyopathy / Q000150:complications*; D016896:Treatment Outcome
keywords: Age; Left ventricular ejection fraction; Outcome, subarachnoid hemorrhage; Takotsubo cardiomyopathy; Transthoracic echocardiography