Cerebral vasospasm after subarachnoid hemorrhage: Developing treatments

Subarachnoid hemorrhage (SAH) can be devastating with high morbidity and mortality. A common sequela is cerebral vasospasm, the narrowing of cerebral blood vessels that can lead to ischemic stroke if not reversed. The current management can vary, though proven treatments include monitoring with transcranial Doppler, avoiding negative fluid balance, a three week course of oral nimodipine, and potential endovascular treatment for direct mechanical reversal of vessel narrowing. However, despite these proven treatment options, vasospasm continues to be poorly understood, anticipated, and ultimately treated. Current research has shown some promise for alternative treatment options, including haptoglobin usage, cerebral spinal fluid (CSF) blood-load reduction, retrieval stent angioplasty, and multimodality monitoring. Here we review the current methods of treatment and research for future treatment modalities being evaluated to combat vasospasm.