Endovascular Therapy for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Cerebral vasospasm is a common and serious complication after aneurysmal subarachnoid hemorrhage and is an important cause of delayed cerebral ischemia and poor neurological outcomes. Although standardized medical management is widely used, effective treatment options for cerebral vasospasm remain limited. Endovascular treatment, including intra-arterial drug infusion and mechanical angioplasty, may relieve vasospasm and improve cerebral perfusion after aneurysmal subarachnoid hemorrhage. However, most available evidence comes from retrospective or observational studies, and high-quality randomized evidence remains insufficient. Milrinone is a phosphodiesterase inhibitor with multiple potentially beneficial effects, including vasodilation, positive inotropic activity, anti-inflammatory properties, and endothelial protection. These effects may make milrinone a promising therapeutic agent for relieving cerebral vasospasm, reducing delayed cerebral ischemia, and ultimately improving clinical outcomes after aneurysmal subarachnoid hemorrhage. This study is a multicenter, prospective, randomized controlled clinical trial designed to evaluate whether early continuous milrinone-based endovascular therapy improves outcomes in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Eligible participants will be randomly assigned to receive either standardized medical management alone or milrinone-based endovascular therapy plus standardized medical management. In the intervention group, patients will receive intra-arterial milrinone during endovascular treatment, with mechanical angioplasty when clinically indicated, followed by continuous intravenous milrinone infusion for 72 hours after intra-arterial administration. The study will evaluate whether this continuous treatment strategy reduces poor neurological outcomes at 3 months after randomization. It will also assess the effects of treatment on delayed cerebral ischemia, vasospasm resolution, cognitive function, quality of life and so on. The results of this trial may provide high-quality evidence for early continuous milrinone-based endovascular therapy as a treatment strategy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

NCT Number	NCT07643922
Lead Sponsor	Beijing Tiantan Hospital Collaborators: The First Affiliated Hospital of Zhengzhou University, Hebei General Hospital, Nanfang Hospital, Southern Medical University, Henan Provincial People's Hospital, Binzhou Medical University, Hunan University of Medicine General Hospital, First Affiliated Hospital of Harbin Medical University, Second Affiliated Hospital, Zhejiang University, School of Medicine, First Affiliated Hospital of Wannan Medical College, Zhongnan Hospital, The First Affiliated Hospital of Nanchang University, First Affiliated Hospital of Xinjiang Medical University, Chinese PLA General Hospital, Shaoyang Central Hospital, Ji an central people's Hospital, The second People's Hospital of Guiyang, China
Conditions	Subarachnoid Hemorrhage, Aneurysmal, Cerebral Vasospasm After Subarachnoid Hemorrhage
Enrollment	306 participants
Start Date	2026-06-03
Primary Completion	2028-12-31 (estimated)
Study Completion	2029-12-31 (estimated)
Updated on ClinicalTrials.gov	2026-06-29