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Purpose of Review <p>Aneurysmal subarachnoid hemorrhage (SAH) has high morbidity and mortality from the initial insult as well as secondary injury from complications of the disease, such as rebleeding of aneurysm, hydrocephalus, seizures, and vasospasm. Arising from many different mechanisms, delayed cerebral ischemia (DCI) increases overall disability and mortality from this disease. Though nimodipine has had long-standing evidence for improving outcomes, many other treatments have been proposed and studied to prevent and treat vasospasm, which is thought to be one mechanism of DCI. Current treatments are reviewed here, and we present a case series on the use of stellate ganglion block (SGB) for treatment of symptomatic vasospasm.</p> Recent Findings <p>We identified all patients with SAH who received SGB as treatment for vasospasm admitted to our center from October 2020 through December 2023 and present a case series of 17 patients who received 30 SGB procedures. No complications of SGB were reported, and 53% of patients had sonographic or radiographic improvement after at least one SGB procedure.</p> Summary <p>There is a need to study and develop more treatments for vasospasm in SAH to reduce morbidity and mortality. SGB, along with other treatments reviewed here (nimodipine, endovascular management, milrinone, lumbar drain, and intrathecal calcium channel blockers), are all promising but randomized clinical trials remain essential for guiding clinical decision-making.</p> Opinion Statement <p>Aneurysmal subarachnoid hemorrhage still carries high morbidity and mortality despite improving access to care for patients and advancements in neurocritical care overall. Most disability is due to delayed cerebral ischemia which has a multifactorial etiology. Vasospasm is thought to be one of its main drivers. Though many agents and treatments have been trialed, few have shown significant promise. Our own institutional practice consists of the use of nimodipine, euvolemia, blood pressure augmentation, and endovascular treatments to help prevent and treat vasospasm and delayed cerebral ischemia. Additionally, after assessing patients’ comorbidities and clinical status, other therapies can also be trialed, such as milrinone and stellate ganglion block. Though there are less data available about these treatments, recent studies have shown promise, including our own experience at our center.</p>

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Stellate Ganglion Block as a Treatment for Vasospasm in Subarachnoid Hemorrhage: A Case Series and Review of Current Treatments

  • 期刊论文

  • 发表日期：

    2025年6月28日

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  • Safa Kaleem,
  • Cali C. M. Callaway,
  • Hooman Kamel,
  • Fernanda Carvalho Poyraz,
  • Judy H. Ch’ang

摘要

Purpose of Review

Aneurysmal subarachnoid hemorrhage (SAH) has high morbidity and mortality from the initial insult as well as secondary injury from complications of the disease, such as rebleeding of aneurysm, hydrocephalus, seizures, and vasospasm. Arising from many different mechanisms, delayed cerebral ischemia (DCI) increases overall disability and mortality from this disease. Though nimodipine has had long-standing evidence for improving outcomes, many other treatments have been proposed and studied to prevent and treat vasospasm, which is thought to be one mechanism of DCI. Current treatments are reviewed here, and we present a case series on the use of stellate ganglion block (SGB) for treatment of symptomatic vasospasm.

Recent Findings

We identified all patients with SAH who received SGB as treatment for vasospasm admitted to our center from October 2020 through December 2023 and present a case series of 17 patients who received 30 SGB procedures. No complications of SGB were reported, and 53% of patients had sonographic or radiographic improvement after at least one SGB procedure.

Summary

There is a need to study and develop more treatments for vasospasm in SAH to reduce morbidity and mortality. SGB, along with other treatments reviewed here (nimodipine, endovascular management, milrinone, lumbar drain, and intrathecal calcium channel blockers), are all promising but randomized clinical trials remain essential for guiding clinical decision-making.

Opinion Statement

Aneurysmal subarachnoid hemorrhage still carries high morbidity and mortality despite improving access to care for patients and advancements in neurocritical care overall. Most disability is due to delayed cerebral ischemia which has a multifactorial etiology. Vasospasm is thought to be one of its main drivers. Though many agents and treatments have been trialed, few have shown significant promise. Our own institutional practice consists of the use of nimodipine, euvolemia, blood pressure augmentation, and endovascular treatments to help prevent and treat vasospasm and delayed cerebral ischemia. Additionally, after assessing patients’ comorbidities and clinical status, other therapies can also be trialed, such as milrinone and stellate ganglion block. Though there are less data available about these treatments, recent studies have shown promise, including our own experience at our center.