Abstract Body: Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition complicated by cerebral vasospasm and deterioration of neurological functions. Statins have been proven to reduce the incidence of vasospasm and limit neurological deterioration with controversial data. We aimed to give a comprehensive assessment of statins in patients with aSAH.

Methods: We retrieved PubMed, Scopus, Web of Science, and the Cochrane Library for Randomized Controlled Trials (RCTs) assessing the efficacy of statins in patients with aSAH from inception to April 2024. Cerebral vasospasm and neurological deterioration were the primary outcomes of interest. Other studied outcomes are delayed ischemic neurological deficits, all-cause mortality, and elevated transaminase levels. STATA 18MP was used to analyze the data using a random-effect model.

Results: A total of nine RCTs comprising 1464 patients, with a mean follow-up of 6 months were included in the final analysis. After 2 weeks of administration, statins were associated with a lower risk of cerebral vasospasm (OR: 0.75, 95% CI: 0.57 to 0.98, p= 0.04; I2= 0.00, p= 0.90), with no significant difference in the incidence of neurological deterioration (OR: 0.92, 95% CI: 0.75 to 1.14, p= 0.45; I2= 0.00, p= 0.84). No significant difference was observed in other reported outcomes.

Conclusion: Statins were associated with reduced vasospasm with no notable improvement in neurological prognosis. However, the 2-week time window of statins is powered by a small sample size, and further large-volume RCTs are warranted.