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.

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).