Statins in Subarachnoid Hemorrhage to Prevent Delayed Cerebral Ischemia: Old Drugs for New Strategies?

Excerpt

Subarachnoid hemorrhage (SAH) caused by a ruptured cerebral aneurysm is probably the most devastating event that can affect the brain. It is a predominantly medical condition, which, after the initial intervention that stops the bleeding (clipping or coiling), can go on to an important sequela of complications. The tools available to the intensivist physician are relatively few. Undoubtedly, the most fearsome complication is delayed cerebral ischemia (DCI), defined as the occurrence of focal neurological deficits or loss of at least 2 points on the Glasgow Coma Scale not attributable to other causes. DCI manifests neuroradiological as an area of ischemic distress that evolves into an infarct and is often the consequence of vasospasm of large vessels. Few drugs and treatments are available to reduce the risk of DCI (e.g., nimodipine, blood pressure manipulation). Among the many tested drugs, much has been written about the function of statins, most notably, an antispastic effect on affected vessels through activation of endothelial nitric oxide expression. The most up-to-date guidelines on SAH (2023 American Heart Association/American Stroke Association and Neurocritical Care Society) do not recommend statins in these patients because of the lack of studies and literature reviews strong enough to demonstrate efficacy on DCI and mortality. …