the early 1980s (46). The drug was firstly used as a carnitine biosynthesis inhibitor to inhibit fatty acid oxidation thus reducing the production of cytotoxic products and blocking the high oxygen use in ischemic conditions (38). In addition to carnitine biosynthesis inhibition, mildronate inhibits carnitine acyltransferase and attenuates carnitine incorporation into the mitochondria (32). Collectively, mildronate prevents the accumulation of ischemic precursors and toxic acylcarnitine products, by inhibiting carnitine █ INTRODUCTION C erebral ischemia is the most important cause of mortality and morbidity following subarachnoid hemorrhage (SAH)-related vasospasm (2,13). Despite numerous studies investigating treatments for SAH-induced vasospasm, effective prevention and therapy are still lacking. Mildronate (2,2,2 triethylhydrazinium, Quaterine, Meldonium, MET-88) is an anti-ischemic drug first produced in Lithuania in AIM: To investigate the effects of an anti-ischemic agent, mildronate, on subarachnoid hemorrhage-induced vasospasm. MATERIAL and METHODS: Rabbits were randomly divided into four groups: control, subarachnoid hemorrhage (SAH), vehicle, and mildronate (n = 8 animals per group). In the treatment group, 200 mg/kg of mildronate were intraperitoneally administered 5 min after the procedure and continued for 3 days as daily administrations of the same dose. At the end of the third day, the cerebrum, cerebellum, and brain stem were perfused, fixated, and removed for histopathological examination. Tissues were examined for arterial wall thickness, luminal area, and hippocampal neuronal degeneration. RESULTS: Mildronate group showed significantly increased luminal area and reduced wall thickness of the basilar artery compared with the subarachnoid hemorrhage group. In addition, the hippocampal cell degeneration score was significantly lower in the mildronate group than in the SAH and vehicle groups. CONCLUSION: These results show that mildronate exerts protective effects against SAH-induced vasospasm and secondary neural injury.