A Randomized, Double-Blind, Placebo-Controlled Pilot Study of Simvastatin in Aneurysmal

Background and Purpose—Studies suggest statins ameliorate aneurysmal subarachnoid hemorrhage (SAH)-induced cerebral vasospasm and ischemic complications. We tested safety and feasibility of simvastatin 80 mg/d for vasospasm prevention in SAH patients. Methods—Thirty-nine statin-naı̈ve Fisher grade 3 SAH subjects were double-blind randomized to receive simvastatin 80 mg/d (n19) or placebo (n20), stratified by Hunt and Hess grade. Primary end points were death and drug morbidity. Results—Mortality was 3/20 in the placebo and 0/19 in the simvastatin group. Study drug was withdrawn in 1 subject in each treatment group for reversible liver enzyme or creatine phosphokinase elevation. Angiographically-confirmed vasospasm occurred in 8/20 placebo and 5/19 simvastatin-treated subjects. Vasospasm-related ischemic infarcts developed in 5/20 placebo and 2/19 simvastatin-treated subjects. Conclusion—Simvastatin for the prevention of delayed cerebral ischemia is safe and feasible after SAH. A larger study is needed to test its efficacy. (Stroke. 2008;39:2891-2893.) Key Words: vasospasm delayed cerebral ischemia clinical trial There are limited treatment options for aneurysmal sub-arachnoid hemorrhage (SAH)-induced vasospasm and subsequent ischemic complications. Statins have pleiotropic effects targeting many processes in the pathogenesis o