Emerging Neurovascular Interventions for the Prevention of Cerebral Vasospasm and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

作者：Dushan Bosotov, Mukhtar Ali Syed, Faiq Aftab, Faraz Sohail, Ravleen Chowdhary, Hamza Yamout, Muhammad Junaid, Alishba Khan, Geetanjali Khot, Syed Ali A Rahat, Ibrahim R Raza · 发表于：Cureus · 年份：2026 · DOI：10.7759/cureus.111891 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Cerebrovascular and Carotid Artery Diseases、Intracerebral and Subarachnoid Hemorrhage Research

Aneurysmal subarachnoid hemorrhage remains a major cause of neurological morbidity and mortality, with delayed cerebral ischemia and cerebral vasospasm representing important contributors to secondary brain injury and unfavorable functional recovery. Although conventional management strategies such as nimodipine administration, hemodynamic augmentation, and endovascular rescue therapy remain central to clinical practice, growing evidence suggests that delayed cerebral ischemia is a multifactorial neurovascular process extending beyond isolated large vessel vasospasm. This systematic review evaluated emerging neurovascular interventions for the prevention and management of cerebral vasospasm and delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, and Web of Science databases for studies published between January 2020 and February 2026 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Nine studies met the eligibility criteria and were included in the qualitative synthesis. The included interventions encompassed endothelin receptor antagonists, localized nicardipine release implants, intra-arterial nimodipine infusion, microcirculatory targeted pharmacologic therapies, anti-inflammatory neuroprotective agents, and autonomic neuromodulatory approaches. Several interventions demonstrated reductions in angiographic vasospas...