Subarachnoid hemorrhage
ICD-10 I60 · ICD-11 8B01

Aneurysmal SAH with Symptomatic Cerebral Vasospasm: When Induced Hypertension Has Not Achieved Neurological Improvement

This protocol is for patients with aneurysmal subarachnoid hemorrhage (aSAH) who develop symptomatic cerebral vasospasm and/or delayed cerebral ischemia (DCI), and in whom initial blood pressure management has not produced the expected neurological improvement — requiring escalation to the next treatment step.

Clinical scenario

Aneurysmal subarachnoid hemorrhage complicated by symptomatic cerebral vasospasm and/or delayed cerebral ischemia. This complication can progress and intensify neurological deficits if not managed promptly and effectively.

Prior treatment did not achieve goals

The initial approach — elevation of systolic blood pressure (induced hypertension) together with maintenance of euvolemia — was employed to reduce the progression and severity of delayed cerebral ischemia. This line did not achieve adequate reduction in DCI progression or the expected neurological improvement, indicating the need to escalate.

Next-step approach

The escalation strategy at this stage involves endovascular rescue therapy directed at reversing the cerebral vasospasm itself. The complete structured regimen — including specific modalities and their application — is available in the full protocol.

Clinical goals

Reversal of cerebral vasospasm and reduction in the progression and severity of delayed cerebral ischemia.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/str.0000000000000436

  • In patients with aSAH and symptomatic vasospasm, elevating systolic BP values may be reasonable to reduce the progression and severity of DCI.
  • In patients with aSAH and severe vasospasm, use of intra-arterial vasodilator therapy may be reasonable to reverse cerebral vasospasm and reduce the progression and severity of DCI.
  • In patients with aSAH and severe vasospasm, cerebral angioplasty may be reasonable to reverse cerebral vasospasm and reduce the progression and severity of DCI.
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