Aneurysmal subarachnoid hemorrhage (aSAH) is a particularly devastating neurologic insult as the majority of patients suffer morbidity and mortality at the time of rupture, and from subsequent complications. While at least one-third of patients die shortly after experiencing a ruptured cerebral aneurysm, ~60% of survivors develop debilitating neurologic deficits throughout their course of treatment. In numerous cases, spastic narrowing of large cerebral vessels, termed cerebral vasospasm, has been associated with delayed cerebral ischemia (DCI) and stroke 4 to 21 days post-hemorrhage. Despite decades of animal research and numerous clinical trials, highly effective pharmacological treatment options for aSAH patients are lacking. Herein, results from clinical trials examining pharmacologic therapies for delayed cerebral vasospasm, DCI and functional outcomes in aSAH patients are discussed, including the current status of nimodipine and other dihydropyridines, endothelin receptor antagonists, magnesium sulfate, and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins).
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