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Research Article | Open Access

Evolving approaches in the management of patients with subarachnoid hemorrhage from 2002 to 2022: The impact of clazosentan and treatment modalities on outcomes

Hajime Maedaa,b, Tsuyoshi Izumoa( ), Kazuaki Okamuraa, Susumu Yamaguchic, Yoichi Morofujia, Takayuki Matsuoa
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
Department of Neurosurgery, Nagasaki Rosai Hospital, Nagasaki 857-0134, Japan
Department of Neurosurgery, Sasebo City General Hospital, Nagasaki 857-8511, Japan
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Abstract

Objective

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

Methods

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).

Results

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.

Conclusion

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.

Keywords

MortalitySubarachnoid hemorrhageRebleedingGeneral anesthesiaPreoperative management

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Brain Hemorrhages
Volume 5 Issue 2,
April 2024
Pages 55-61
DOI: 10.1016/j.hest.2023.11.006
Cite this article:
Maeda H, Izumo T, Okamura K, et al. Evolving approaches in the management of patients with subarachnoid hemorrhage from 2002 to 2022: The impact of clazosentan and treatment modalities on outcomes. Brain Hemorrhages, 2024, 5(2): 55-61. https://doi.org/10.1016/j.hest.2023.11.006

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Received: 27 September 2023
Revised: 01 November 2023
Accepted: 06 November 2023
Published: 07 November 2023
© 2023 International Hemorrhagic Stroke Association.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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