Recognizing the treatment options for refractory vasospasm to recommended management protocols will allow clinicians to consider contingency treatments in the event of severe, refractory vasospasm.

We present a case report of a patient treated at our institution who had severe diffuse refractory vasospasm with neuroimaging concerning for right medial cerebral artery (MCA) ischemic stroke. The patient fully recovered following treatment which included management recommendations per guidelines, milrinone for inducing hypertension, intrathecal nicardipine, and bilateral stellate ganglion block (SCG). Digital subtraction angiography before and after the right SGB showed improvement in vessel diameter in the right MCA, prompting us to perform a left SGB.

The systematic review is being conducted according to established methodological standards following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search strategy was created with input from a medical librarian. We searched the PubMed, Scopus, and Embase databases through the last search date of September 27, 2022. No restrictions were placed on date, language, or country of publication.

A total of 1460 references were identified, and 463 duplicates were removed, producing a final reference count of 997 studies to peruse. CT, RA, and CR are conducting ongoing study revisions.

A variety of complementary therapies are available and could be used in the management of refractory vasospasm. Although these are alternative therapies, they are efficacious in managing this condition, and physicians should be aware of these options.