Abstract
We explored whether acute atorvastatin treatment would improve clinical outcomes and reduce the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage in elderly Chinese adults. Patients (60 to 90 years old) were admitted to intensive care units after surgery to clip or embolize their aneurysms. We assessed 592 patients and assigned 159 to receive atorvastatin (20 mg/day) and 158 to receive placebo once daily for up to 14 days. The primary outcome was the Glasgow outcome scale at 6 months, and secondary outcomes were cerebral vasospasm, 30-days all-cause mortality, cerebral infarction, and delayed ischemic neurological deficit. The incidence of postoperative cerebral vasospasm (39.3% vs 56%, P =0.004) and cerebral infarction (18.7% vs 27.3%, P=0.027) were significantly lower in the atorvastatin group. The study did not detect benefits in the use of atorvastatin for 6 months clinical outcome or 30-day all-cause mortality, but it suggests that atorvastatin together with nimodipine can reduce cerebral vasospasm and cerebral infarction after subarachnoid hemorrhage.
Highlights
Spontaneous subarachnoid hemorrhage (SAH) is the most common cerebral vascular disease, and 75% of SAHs are caused by rupture of an intracranial aneurysm [1,2,3]
No data were lost in the other assessments such as all-cause mortality at 30 days after aneurysmal SAH (aSAH), cerebral vasospasm (CVS), vasospasm-related new infarction and delayed ischemic neurological deficit (DIND) due to vasospasm within 2 weeks post-aSAH
20 mg/day atorvastatin for up to 14 days after aSAH operation had no significant effect on the primary endpoint of 6 month Glasgow outcome scale (GOS) or secondary endpoint of 30day all-cause mortality
Summary
Spontaneous subarachnoid hemorrhage (SAH) is the most common cerebral vascular disease, and 75% of SAHs are caused by rupture of an intracranial aneurysm [1,2,3]. The fatality rate is 40%, and many survivors have long-term neurological and cognitive impairment. SAH is still associated with mortality at one month for half of all patients, and another quarter is left disabled [4, 5]. Even though some patients survive the initial aneurysmal SAH (aSAH), several complications can contribute to poor outcome. One of the most important causes of resulting mortality and morbidity is cerebral vasospasm (CVS) and CVS- related ischemic infarcts causing delayed cerebral ischemia (DCI) [6]. After aSAH, CVS was observed on angiography in more than
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