Aneurysmal subarachnoid hemorrhage (aSAH) continues to be associated with significant morbidity and mortality despite advances in care and aneurysm treatment strategies. Cerebral vasospasm continues to be a major source of clinical worsening in patients. We intended to review the clinical and experimental aspects of aSAH and identify strategies that are being evaluated for the treatment of vasospasm. A literature review on aSAH and cerebral vasospasm was performed. Available treatments for aSAH continue to expand as research continues to identify new therapeutic targets. Oral nimodipine is the primary medication used in practice given its neuroprotective properties. Transluminal balloon angioplasty is widely utilized in patients with symptomatic vasospasm and ischemia. Prophylactic "triple-H" therapy, clazosentan, and intraarterial papaverine have fallen out of practice. Trials have not shown strong evidence supporting magnesium or statins. Other calcium channel blockers, milrinone, tirilazad, fasudil, cilostazol, albumin, eicosapentaenoic acid, erythropoietin, corticosteroids, minocycline, deferoxamine, intrathecal thrombolytics, need to be further investigated. Many of the current experimental drugs may have significant roles in the treatment algorithm, and further clinical trials are needed. There is growing evidence supporting that early brain injury in aSAH may lead to significant morbidity and mortality, and this needs to be explored further.

中文翻译：

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动脉瘤性蛛网膜下腔出血的临床和实验方面。

尽管护理和动脉瘤治疗策略取得了进步，动脉瘤性蛛网膜下腔出血（aSAH）仍然与显着的发病率和死亡率相关。脑血管痉挛仍然是患者临床恶化的主要原因。我们打算回顾 aSAH 的临床和实验方面，并确定正在评估的治疗血管痉挛的策略。对aSAH和脑血管痉挛进行文献综述。随着研究不断发现新的治疗靶点，aSAH 的可用治疗方法不断扩大。鉴于其神经保护特性，口服尼莫地平是实践中使用的主要药物。腔内球囊血管成形术广泛应用于有症状的血管痉挛和缺血的患者。预防性“三 H”疗法、克拉佐生坦和动脉注射罂粟碱已不再实用。试验尚未显示出支持镁或他汀类药物的有力证据。其他钙通道阻滞剂，米力农，替拉扎德，法舒地尔，西洛他唑，白蛋白，二十碳五烯酸，促红细胞生成素，皮质类固醇，米诺环素，去铁胺，鞘内溶栓剂，需要进一步研究。目前许多实验药物可能在治疗算法中发挥重要作用，还需要进一步的临床试验。越来越多的证据表明，aSAH 的早期脑损伤可能导致显着的发病率和死亡率，这需要进一步探讨。