This study aimed to assess the changes in patient demographics, aneurysm characteristics, and treatment modalities for subarachnoid hemorrhage (SAH) over the past two decades.

We analyzed SAH 6,446 patients between 2002 and 2022, which was divided into three periods: 2002–2011 (FP), 2012–2021 (SP), and post-clazosentan 2022 (PC). The final cohort included 2878, 2016, and 152 patients in FP, SP, and PC groups, respectively. We examined patient demographics, surgical procedures, spasm prevention therapy, and delayed ischemic neurological deficits (DIND).

The mean age of the patients increased over the study period (64, 66, and 68 years in FP, SP, and PC groups, respectively). Clipping was the predominant method during FP (79 %); however, coiling surpassed clipping in 2022 (coiling vs. clipping, 47 % vs. 46.3 %). Before clazosentan introduction, fasudil was the primary spasm prevention treatment (>80 %); however, its use decreased (63.9 %) after clazosentan introduction. DIND varied across FP, SP, and PC groups (37.4 %, 24.2 %, and 16.7 % respectively). Age and generation were significantly associated with DIND and irreversibility.

Regarding the management of patients with SAH, shift from clipping to coiling, and the introduction of new spasm prevention treatments such as clazosentan were observed, led to a decrease in DIND.