蜘蛛網膜下腔出血 (aneurysmal subarachnoid hemorrhage, aSAH) 後引起的血管痙攣通常在第三天開始有臨床表現，且在第七 ~ 第八天時最明顯。傳統上使用triple H療法 ( 高血壓、高血容量、血液稀釋 )，但文獻發現更易導致肺水腫和低血鈉，目前已不再適用。現今建議等容積或是高血壓，為治療血管痙攣較佳的方式；但若仍無法緩解，經動脈輸注 (intra-arterial, IA) 血管擴張劑，例如nimodipine 被發現可以改善發生血管痙攣的影像學及臨床症狀，可作為治療的選擇之一。我們報告2 個案例都是位在前交通動脈的動脈瘤破裂後， 所導致的SAH。他們皆有接受手術或動脈瘤處置，並且使用口服nimodipine 每4 個小時60 mg，完成21 天的療程，但是分別在第九天和第五天時發生意識不清等神經學惡化症狀，並藉由影像學診斷血管痙攣，在維持相當的體液及拉高血壓後，狀況沒有改善，所以分別給與腦動脈輸注nimodipine 1 次和3 次治療後，兩者影像學和神經學皆有顯著改善，順利轉出加護病房。SAH 後引起的血管痙攣，給與IA 血管擴張劑以影像學上的改善的比例優於臨床症狀的改善，臨床上雖非常規治療但可作為治療選擇之一，我們報告2 例影像學和臨床症狀皆改善成功的案例，但若要確立IA 血管擴張劑的治療效果仍需要更大型的前瞻性研究來回答。

Vasospasm or delayed ischemic neurological deficit after aneurysmal subarachnoid hemorrhage (aSAH) usually starts no less than day 3 after onset, and reach a peak on days 7–8. Oral nimodipine is an important strategy for a better neurological outcome. Triple H (i.e., hypertension, hypervolemia, and hemodilution) is associated with complications. It is now recommended to maintain euvolemia and induced hypertension for vasospasm. If vasospasm is not relieved, intra-arterial (IA) vasodilators show good clinical response. Here, we report 2 cases with symptomatic vasospasm successfully treated with IA nimodipine. We present 2 cases with anterior communicating artery aneurysm rupture leading to SAH. They both took nimodipine orally 60 mg every 4 hr for 21 days after the procedure. However, they still experienced vasospasm on day 9 and day 5, respectively. Because of mild hypervolemia and hypertension failing, IA vasodilation agents were considered. After treated with IA nimodipine once and three times, their angiographic and neurological responses were satisfying after treatments. Due to stable conditions, they were transferred to the general ward successfully. The vasospasm caused by SAH shows much more improvement in angiographic than neurological response by giving IA vasodilators. Although it is not the conventional treatment to date, it still can be used as one of the options. We report 2 successful cases in angiographic and neurological responses. However, we need more well-established and prospective studies to prove the efficacy of IA vasodilators in vasospasm of aSAH.