OBJECTIVE: To evaluate the evidence for use of hydroxymethylglutaryl coenzyme A 
reductase inhibitors (statins) for the prevention and management of cerebral 
vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).
DATA SOURCES: Literature searches were conducted using MEDLINE (1966-July 2007) 
and the Cochrane Database (2007, Issue 2). Search terms included HMG-CoA 
reductase inhibitors, statins, subarachnoid hemorrhage, and vasospasm. Other 
data sources were identified from select bibliographies.
STUDY SELECTION AND DATA EXTRACTION: All controlled trials evaluating statins 
for the prevention and management of cerebral vasospasm after aSAH and published 
in the English language were included for review. Clinical and surrogate markers 
for cerebral vasospasm and outcomes were assessed.
DATA SYNTHESIS: Cerebral vasospasm, which may occur after aSAH, is associated 
with serious morbidity and significant mortality. Evidence suggests that statins 
have noteworthy biochemical effects through inhibition of nicotinamide adenine 
dinucleotide phosphate oxidase and superoxide production and up-regulation and 
activation of endothelial nitric oxidase synthase and nitric oxidase production 
via inhibition of geranylgeranylation of RhoA and Rac1 guanosine 
triphosphatases. Researchers have proposed that these effects may have a role in 
preventing or reducing vasospasm after aSAH. One matched control study and 3 
placebo-controlled trials (1 with an additional post hoc analysis) have 
described use of statins for the prevention and management of cerebral vasospasm 
after aSAH. These data focused on differing primary endpoints; however, 
reductions in clinical vasospasm and middle cerebral artery transcranial doppler 
velocity, improved functional outcomes, enhanced autoregulation indices 
incidence, improvements in duration and time of impaired cerebral 
autoregulation, and reductions in rescue therapy have been reported.
CONCLUSIONS: Current data suggest that statins may be a reasonable treatment 
option for the prevention and management of cerebral vasospasm after aSAH. 
However, results from large, well-controlled trials have not been published.