In the absence of randomized controlled trials, a meta-analysis of retrospective studies suggested that antiplatelet treatment was associated with reduced mortality and better functional outcomes in aneurysmal subarachnoid hemorrhage patients after endovascular treatment without an increased incidence of hemorrhagic complications. Long-term antiplatelet treatment was also associated with a decrease in the incidence of Delayed cerebral ischemia. Well-designed randomized controlled trials are warranted and updated meta-analyses are needed to verify these findings 1).
Regular administration of aspirin might have a positive impact on DCI risk and outcome of SAH patients, without increasing the risk for clinically relevant bleeding events. In a SAH cohort, dual antiplatelet therapy showed no additional benefit on DCI risk but increased the likelihood of major bleeding events 2)
Metaanalysis indicated that the use of statins decreases the occurrence of cerebral vasospasm, whereas did not support a beneficial effect of statins on the occurrence of delayed ischemic neurological deficit (DIND), death or poor neurological outcomes in patients with aneurysmal SAH 3).
Local intraparenchymal neuromonitoring in the anterior cerebral artery/middle cerebral artery watershed area might detect the vast majority of delayed cerebral ischemias for all intracranial aneurysm locations, except for basilar artery aneurysms. In ACA and AcomA aneurysms, bilateral DCI of the ACA territory was common, and bilateral probe positioning might be considered for monitoring high-risk patients. Non-focal monitoring methods might be preferably used after BA aneurysm rupture 4).