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血管内治疗动脉瘤性蛛网膜下腔出血并发神经源性肺水肿和应激性心肌病：10例报告

Endovascular Therapy for Aneurysmal Subarachnoid Hemorrhage Complicated by Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy: A Report of Ten Cases.

作者信息

Nonaka Senshu, Oishi Hidenori, Tsutsumi Satoshi, Ishii Hisato

机构信息

Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.

Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.

出版信息

Asian J Neurosurg. 2020 Feb 25;15(1):113-119. doi: 10.4103/ajns.AJNS_331_19. eCollection 2020 Jan-Mar.

DOI:10.4103/ajns.AJNS_331_19
PMID:32181183
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7057902/
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.

摘要

目的

动脉瘤性蛛网膜下腔出血（aSAH）患者可能会进一步并发神经源性肺水肿（NPE）和应激性心肌病（TCM），预后较差。本研究旨在验证血管内治疗对合并NPE和TCM的aSAH患者的疗效。

材料与方法

回顾性评估诊断为合并NPE和TCM的aSAH并接受血管内治疗的患者。

结果

在过去5年中，共有10例aSAH女性患者同时被诊断为NPE和TCM。其中6例为高级别aSAH（Hunt和Hess分级IV级和V级），4例为低级别aSAH（II级和III级）。破裂动脉瘤的位置：5例位于颈内动脉-后交通动脉交界处，2例位于前交通动脉，2例位于椎动脉，1例位于大脑中动脉。这些动脉瘤通过血管内治疗成功栓塞，无任何与手术相关的并发症。出院后6个月根据改良Rankin量表评估的临床结局：4例患者为0分，2例为1分，1例为3分，3例为5分。

结论

血管内治疗对于合并NPE和TCM的高级别aSAH患者可能是一种可行的替代治疗措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b85/7057902/bfa9fa147652/AJNS-15-113-g012.jpg
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