OBJECTIVE: Statins, which improve the bioavailability of endogenous nitric oxide 
and upregulate endothelial nitric oxide synthase, have been used to prevent 
cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The objective of 
this study was to determine whether statin therapy diminished vasospasm-induced 
ischemia as assessed using daily measurements of serum S100B, a biomarker for 
cerebral ischemia, and computed tomography measurement of ischemic lesion 
volume.
DESIGN: Single-center study of cases and historical controls.
SETTING: Neurointensive care unit in a university hospital.
PATIENTS: Consecutive patients with aneurysmal subarachnoid hemorrhage treated 
with clipping or coiling within 96 hrs of symptom onset (n = 278) were included 
from April 2004 to October 2007.
INTERVENTION: Oral atorvastatin, 40 mg/day for 21 days, was used routinely 
starting on December 1, 2005, in 142 patients, who were compared with the 136 
patients managed earlier.
MEASUREMENTS AND MAIN RESULTS: Ischemic lesion size was measured using computed 
tomography on the last available scan and serum S100B was assayed daily for 15 
days after admission. Angiographic narrowing was semiquantitatively assessed in 
patients with vasospasm. In the overall population, cerebral vasospasm was 
significantly less common in the statin-treated group. Severity of vasospasm, as 
assessed on the most severe angiogram, was lowered with statin. Statins 
significantly reduced volume of ischemia in patients with vasospasm and an 
uncomplicated coiling procedure. S100B levels were significantly lower in 
statin-treated patients, and the decrease was greatest among high-grade patients 
(World Federation of Neurological Surgeons 3-5). No differences were found 
between statin-treated and untreated groups regarding rescue therapy intensity 
or 1-yr clinical outcomes.
CONCLUSIONS: Atorvastatin reduces the incidence, the severity and the ischemic 
consequences of vasospasm as assessed on computed tomography. In high-grade 
World Federation of Neurological Surgeons patients, atorvastatin decreases serum 
levels of S100B, a biomarker of brain ischemia. Despite these positive effects 
on biomarkers, no improvement of outcome was seen in the overall population, 
although there was a tendency for a better clinical outcome in high-grade 
patients.