OBJECTIVE: Cerebral vasospasm is a major source of morbidity and mortality 
following aneurysmal subarachnoid hemorrhage (SAH). A variety of therapies have 
been utilized to prevent or treat vasospasm. Despite the large number of 
clinical trials, few randomized controlled trials (RCTs) of sufficient quality 
have been published. We review the RCTs and meta-analyses in the literature 
regarding the treatment and prevention of cerebral vasospasm following 
aneurysmal SAH.
METHODS: A literature search of MEDLINE, the Cochrane Controlled Trials 
Registry, and the National Institutes of Health/National Library of Medicine 
clinical trials registry was performed in January 2010 using predefined search 
terms. These trials were critically reviewed and categorized based on 
therapeutic modality.
RESULTS: Forty-four RCTs and 9 meta-analyses met the search criteria. 
Significant findings from these trials were analyzed. The results of this study 
were as follows: nimodipine demonstrated benefit following aneurysmal SAH; other 
calcium channel blockers, including nicardipine, do not provide unequivocal 
benefit; triple-H therapy, fasudil, transluminal balloon angioplasty, 
thrombolytics, endothelin receptor antagonists, magnesium, statins, and 
miscellaneous therapies such as free radical scavengers and antifibrinolytics 
require additional study. Tirilazad is ineffective.
CONCLUSIONS: There are many possible successful treatment options for preventing 
vasospasm, delayed ischemic neurologic deficits, and poor neurologic outcome 
following aneurysmal subarachnoid hemorrhage; however, further multicenter RCTs 
need to be performed to determine if there is a significant benefit from their 
use. Nimodipine is the only treatment that provided a significant benefit across 
multiple studies.