# Successful Management of Subarachnoid Hemorrhage Complicated by Takotsubo Cardiomyopathy Using Distal Transradial Access (dTRA) Coiling and Integrated Pharmacotherapy Under Intra-aortic Balloon Pumping (IABP) Support: A Stroke-Heart Syndrome Case

## TL;DR

A 55-year-old woman with subarachnoid hemorrhage and Takotsubo cardiomyopathy was successfully treated using a combination of IABP, dTRA coiling, and targeted medications.

## Contribution

This case demonstrates a novel integrative approach to managing neurocardiac comorbidities outside a formal ICU.

## Key findings

- Multidisciplinary care with IABP and dTRA coiling stabilized the patient's condition.
- Pharmacologic strategies including ARNIs and MRAs improved outcomes.
- Successful management was achieved in a high care unit without ICU transfer.

## Abstract

Takotsubo cardiomyopathy (TCM) complicating subarachnoid hemorrhage (SAH) presents unique management challenges due to the risk of cardiogenic shock and cerebral ischemia. We report the case of a 55-year-old woman with SAH and severe TCM treated successfully through multidisciplinary care involving intra-aortic balloon pumping (IABP), endovascular aneurysm coiling via distal transradial access (dTRA), and a structured pharmacologic strategy, following hemodynamic stabilization, that included angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), clazosentan, and perampanel. This case illustrates the feasibility of managing complex neurocardiac comorbidity using integrative, anticipatory strategies in a high care unit (HCU) managed directly by neurosurgeons, outside a formal intensive care unit (ICU).