: The leading cause of morbidity and mortality after surviving the rupture of an 
intracranial aneurysm is delayed cerebral ischaemia (DCI). We present an update 
of recent literature on the current status of prevention and treatment 
strategies for DCI after aneurysmal subarachnoid haemorrhage. A systematic 
literature search of three databases (PubMed, ISI Web of Science, and Embase) 
was performed. Human clinical trials assessing treatment strategies, published 
in the last 5 yr, were included based on full-text analysis. Study data were 
extracted using tables depicting study type, sample size, and outcome variables. 
We identified 49 studies meeting our inclusion criteria. Clazosentan, magnesium, 
and simvastatin have been tested in large high-quality trials but failed to show 
a beneficial effect. Cilostazol, eicosapentaenoic acid, erythropoietin, heparin, 
and methylprednisolone yield promising results in smaller, non-randomized or 
retrospective studies and warrant further investigation. Topical application of 
nicardipine via implants after clipping has been shown to reduce clinical and 
angiographic vasospasm. Methods to improve subarachnoid blood clearance have 
been established, but their effect on outcome remains unclear. Haemodynamic 
management of DCI is evolving towards euvolaemic hypertension. Endovascular 
rescue therapies, such as percutaneous transluminal balloon angioplasty and 
intra-arterial spasmolysis, are able to resolve angiographic vasospasm, but 
their effect on outcome needs to be proved. Many novel therapies for preventing 
and treating DCI after aneurysmal subarachnoid haemorrhage have been assessed, 
with variable results. Limitations of the study designs often preclude definite 
statements. Current evidence does not support prophylactic use of clazosentan, 
magnesium, or simvastatin. Many strategies remain to be tested in larger 
randomized controlled trials.
CLINICAL TRIAL REGISTRATION: This systematic review was registered in the 
international prospective register of systematic reviews.
PROSPERO: CRD42015019817.