Early Blood Pressure Intervention After Coiling or Clipping for Subarachnoid Hemorrhage

Early Blood Pressure Intervention After Coiling or Clipping for Subarachnoid Hemorrhage

The goal of this clinical trial is to learn if elevating postoperative blood pressure works to improve prognosis in aneurysmal subarachnoid hemorrhage (aSAH) patients. The main questions it aims to answer are:

Does elevating postoperative blood pressure can improve the prognosis of aSAH ? What safety problems do participants have when received elevating blood pressure measurement?

Participants will:

Receive elevating or lowering blood pressure therapy in 72 hours after randomization, in order to maintain blood pressure within predefined target ranges Receive follow-up at 30 days, 90 days, and 180 days after randomization

Inclusion Criteria:

• 1) Aged 18-75 years;

  2) Patients who underwent clipping or endovascular intervention within 72 hours post-ictus;

  3) Intracranial aneurysm diagnosis confirmed by operating surgeons (including neurosurgeons or neurointerventionalists) through imaging findings, intraoperative visualization, or angiography, with subarachnoid hemorrhage (SAH) attributable to the ruptured aneurysm lesion (verified via imaging, xanthochromic cerebrospinal fluid, or intraoperative observation);

  4) Hunt-Hess grade 1-4 at onset;

Exclusion Criteria:

• 1) Presence of untreated intracranial aneurysms with rupture risk;

  2) Moderate-to-severe cerebral vasospasm confirmed by pre-enrollment digital subtraction angiography (DSA), transcranial Doppler (TCD), or computed tomography angiography (CTA);

  3) Intracranial massive hematoma (e.g., volume >30 mL with midline shift >5 mm) causing severe cerebral herniation, as evidenced by admission CT or other imaging modalities;

  4) Prior cranial neurosurgery for other central nervous system disorders;

  5) Comorbid major systemic diseases or multi-organ dysfunction with life expectancy <1 year, potentially compromising study implementation or follow-up observations;

  6) Poorly controlled hypertension despite regular antihypertensive medication (e.g., systolic blood pressure >160 mmHg during pharmacotherapy);

  7) Pre-onset modified Rankin Scale (mRS) score >2 points, indicating disability from other causes;

  8) Intraoperative major complications including but not limited to massive cerebral hemorrhage, hypovolemic shock, or malignant brain swelling;

  9) Anticipated inability to complete scheduled follow-up assessments within 180 days;

  10) Pregnancy.