**7.8 Calcium channel blockers for aneurysmal subarachnoid hemorrhage**

It is essential to review the cause behind intracranial arterial spasm, mechanisms, diagnostic tools, and management to understand the role of CCBs in vasospasm among patients with aneurysmal subarachnoid hemorrhage.

Vascular calcification is specific for arteries, which can involve all arteries, including the carotid artery and cerebral arteries. Intracranial arterial calcification (IAC) was first detected in the early 1960s. It is associated with atherosclerosis, especially in older people. Vascular calcification is an integral part of the active process of atherosclerosis, occurring in up to 90% of atherosclerotic lesions. Recent clinical studies have consistently found the intracranial internal carotid artery (IICA) to be the most common site of IAC. The incidence of IICA calcification has been reported

to range from 60 to 90% according to ethnicity, age, and stroke or other risk factors. The vertebral artery is the second most common artery affected by calcification, while other arteries have been affected only by less than 5%. An unenhanced CT scan is the most accessible and direct method to evaluate IAC in patients.

The prevalence of intracranial artery calcification is:


Risk factors of intracranial artery calcification:

Advanced age. Diabetes mellitus. Hypercholesterolemia. Hypertension. History of cardiovascular disease. Excessive alcohol intake. End-stage renal disease with long duration of hemodialysis [11–13].
