Fasudil is believed to be at least equally effective as nimodipine for the 
prevention of cerebral vasospasm and subsequent ischemic injury in patients 
undergoing surgery for subarachnoid hemorrhage (SAH). We report the final 
results of a randomized, open trial to compare the efficacy and safety of 
fasudil with nimodipine. A total of 63 patients undergoing surgery for SAH 
received fasudil and 66 received nimodipine between 1998 and 2004. Symptomatic 
vasospasm, low density areas on computed tomography (CT), clinical outcomes, and 
adverse events were all recorded, and the results were compared between the 
fasudil and nimodipine groups. Absence of symptomatic vasospasm, occurrence of 
low density areas associated with vasospasm on CT, and occurrence of adverse 
events were similar between the two groups. The clinical outcomes were more 
favorable in the fasudil group than in the nimodipine group (p = 0.040). The 
proportion of patients with good clinical outcome was 74.5% (41/55) in the 
fasudil group and 61.7% (37/60) in the nimodipine group. There were no serious 
adverse events reported in the fasudil group. The present results suggest that 
fasudil is equally or more effective than nimodipine for the prevention of 
cerebral vasospasm and subsequent ischemic injury in patients undergoing surgery 
for SAH.