Usefulness of Cilostazol and Atorvastatin for Preventing Vasospasm after Subarachnoid Hemorrhage

Abstract

Cilostazol, a selective inhibitor of phosphodiesterase 3, is a peripheral vasodilator and an anti-inflammatory agent and causes antiplatelet aggregation; therefore, it may help attenuate vasospasm after subarachnoid hemorrhage (SAH). Statins are known to have pleiotropic vascular effects, some of which may interrupt the pathogenesis of delayed neurological deficits following SAH. We evaluated the effects of administration of both cilostazol and atorvastatin in preventing cerebral vasospasm following SAH in 216 patients treated with surgical clipping three days after SAH between 1999 and 2011. The patients were classified into two groups: 139 controls (Group A) and 46 patients (Group B) who received 200 mg/day cilostazol and 5 mg/day atorvastatin from postoperative Day 2 to Day 14. As a result, the incidence of vasospasm as observed on angiography, symptomatic vasospasm, and new cerebral infarction due to vasospasm as observed on CT were apparently lower in the cilostazol and atorvastatin group than in the control group. Cilostazol and atorvastatin may be able to prevent vasospasm; however, simultaneous investigations in multiple institutions are required to further understand and clinically apply these drugs.