AI Chat Paper
Note: Please note that the following content is generated by AMiner AI. SciOpen does not take any responsibility related to this content.
{{lang === 'zh_CN' ? '文章概述' : 'Summary'}}
{{lang === 'en_US' ? '中' : 'Eng'}}
Chat more with AI
Powered by AMiner. Clicking this button will take you away from SciOpen.
Home Brain Hemorrhages Article
PDF (851.5 KB)
Cite
EndNote(RIS) BibTeX
Collect
Submit Manuscript AI Chat Paper
Show Outline
Outline
Show full outline
Hide outline
Outline
Show full outline
Hide outline
Research Article | Open Access

A high cardiothoracic ratio increases the risk of severe pulmonary complications after early initiation of clazosentan in patients with aneurysmal subarachnoid hemorrhage

Rikuo Nishii, Tsuyoshi Ohta( ), Nobuyuki Fukui, Masaomi Koyanagi, Masanori Goto, Junichi Takeda, Ryu Fukumitsu, Tadashi Sunohara, Yuki Takano, Kunimasa Teranishi, Kota Nakajima, Yuji Naramoto, Yasuhiro Yamamoto, Satohiro Kawade, Ryo Sakisuka, Takateru Takamatsu, Masanori Tokuda, Hikari Tomita, Mai Yoshimoto, Nobuyuki Sakai
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Show Author Information

Abstract

Objective

Pulmonary complications, which are occasionally severe, are common adverse events following the administration of clazosentan. This study aimed to identify factors associated with severe pulmonary adverse events due to clazosentan after aneurysmal subarachnoid hemorrhage (aSAH).

Methods

We conducted a retrospective study of 59 patients transported to our hospital and diagnosed with aSAH between April 2022 and May 2023.

Results

The analysis included 33 patients who were treated with clazosentan. Pulmonary complications occurred in 20 patients (61 %) and clazosentan administration was discontinued due to severe pulmonary complications in 7 patients (21 %). The cardiothoracic ratio on admission was significantly higher (57 % vs. 49 %, p = 0.0081) and clazosentan was initiated earlier after aSAH onset (42 vs. 66 h, p = 0.047) in patients who discontinued clazosentan compared with patients who completed administration of clazosentan. The median duration of clazosentan administration was 3.2 days in the discontinuation group. No significant associations were found between the time of clazosentan initiation and the incidence of angiographic vasospasm, delayed cerebral ischemia, or 90-day modified Rankin scale.

Conclusions

The risk of severe pulmonary complications is higher in patients with high cardiothoracic ratios on admission, and delaying clazosentan initiation may prevent pulmonary complications even in high-risk cases.

Keywords

Aneurysmal subarachnoid hemorrhageCardiothoracic ratioPulmonary complications

References

1

Etminan N, Chang HS, Hackenberg K, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: A systematic review and meta-analysis. JAMA Neurol. 2019;76(5):588–597. https://doi.org/10.1001/jamaneurol.2019.0006.
Crossref Google Scholar
2

Schatlo B, Fung C, Stienen MN, et al. Incidence and outcome of aneurysmal subarachnoid hemorrhage: The swiss study on subarachnoid hemorrhage (Swiss SOS). Stroke. 2021;52(1):344–347. https://doi.org/10.1161/STROKEAHA.120.029538.
Crossref Google Scholar
3

Endo H, Hagihara Y, Kimura N, et al. Effects of clazosentan on cerebral vasospasm-related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients. J Neurosurg. 2022;137(6):1707–1717. https://doi.org/10.3171/2022.2.JNS212914.
Crossref Google Scholar
4

Vajkoczy P, Meyer B, Weidauer S, et al. Clazosentan (AXV-034343), a selective endothelin A receptor antagonist, in the prevention of cerebral vasospasm following severe aneurysmal subarachnoid hemorrhage: results of a randomized, double-blind, placebo-controlled, multicenter phase Ⅱa study. J Neurosurg. 2005;103(1):9–17. https://doi.org/10.3171/jns.2005.103.1.0009.
Crossref Google Scholar
5

Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39(11):3015–3021. https://doi.org/10.1161/STROKEAHA.108.519942.
Crossref Google Scholar
6

Macdonald RL, Higashida RT, Keller E, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol. 2011;10(7):618–625. https://doi.org/10.1016/S1474-4422(11)70108-9.
Crossref Google Scholar
7

Macdonald RL, Higashida RT, Keller E, et al. Randomized trial of clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Stroke. 2012;43(6):1463–1469. https://doi.org/10.1161/STROKEAHA.111.648980.
Crossref Google Scholar
8

Fujimura M, Joo JY, Kim JS, et al. Preventive effect of clazosentan against cerebral vasospasm after clipping surgery for aneurysmal subarachnoid hemorrhage in Japanese and Korean patients. Cerebrovasc Dis. 2017;44(1–2):59–67. https://doi.org/10.1159/000475824.
Crossref Google Scholar
9

Yu W, Huang Y, Zhang X, Luo H, et al. Effectiveness comparisons of drug therapies for postoperative aneurysmal subarachnoid hemorrhage patients: network meta-analysis and systematic review. BMC Neurol. 2021;21(1):294.
Crossref Google Scholar
10

Imamura H, Tani S, Adachi H, et al. Comparison of symptomatic vasospasm after surgical clipping and endovascular coiling. Neurol Med Chir (tokyo). 2022;62(5):223–230. https://doi.org/10.2176/jns-nmc.2021-0126.
Crossref Google Scholar
11

Shen J, Huang KY, Zhu Y, et al. Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2017;127(2):291–301. https://doi.org/10.3171/2016.5.JNS152900.
Crossref Google Scholar
12

Suarez JI. Diagnosis and management of subarachnoid hemorrhage. Continuum (Minneap Minn) 2015;21(5 Neurocritical Care):1263-1287. 10.1212/CON.0000000000000217.
Crossref Google Scholar
13

Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–458.
Crossref Google Scholar
14

Juif PE, Dingemanse J, Ufer M. Clinical Pharmacology of clazosentan, a selective endothelin A receptor antagonist for the prevention and treatment of aSAHrelated cerebral vasospasm. Front Pharmacol. 2020;11. https://doi.org/10.3389/fphar.2020.628956628956.
Crossref Google Scholar
15

Vercauteren M, Trensz F, Pasquali A, et al. Endothelin ETA receptor blockade, by activating ETB receptors, increases vascular permeability and induces exaggerated fluid retention. J Pharmacol Exp Ther. 2017;361(2):322–333. https://doi.org/10.1124/jpet.116.234930.
Crossref Google Scholar
16

Pontes JPM, Santos MDC, Gibram FC, et al. Efficacy and safety of clazosentan after aneurysmal subarachnoid hemorrhage: an updated meta-analysis. Neurosurgery. 2023. https://doi.org/10.1227/neu.0000000000002601.
Crossref Google Scholar
17

Truszkiewicz K, Porȩba R, Gać P. Radiological cardiothoracic ratio in evidencebased medicine. J Clin Med. 2021;10(9).
Crossref Google Scholar
18

Solenski NJ, Haley Jr EC, Kassell NF, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the multicenter cooperative aneurysm study. Crit Care Med. 1995;23(6):1007–1017. https://doi.org/10.1097/00003246-199506000-00004.
Crossref Google Scholar
19

Messina A, Longhitano Y, Zanza C, et al. Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality: A systematic review and metanalysis. Eur J Anaesthesiol. 2023;40(6):442–449. https://doi. org/10.1097/EJA.0000000000001829.
Crossref Google Scholar
20

Lozada-Martínez ID, Rodríguez-Gutiérrez MM, Ospina-Rios J, et al. Neurogenic pulmonary edema in subarachnoid hemorrhage: relevant clinical concepts. Egypt J Neurosurg. 2021;36(1):27. https://doi.org/10.1186/s41984-021-00124-y.
Crossref Google Scholar
21

Connolly Jr ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–1737. https://doi.org/10.1161/STR.0b013e3182587839.
Crossref Google Scholar
22

Schmidt TP, Weiss M, Hoellig A, et al. Revisiting the timeline of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: toward a temporal risk profile. Neurocrit Care. 2022;37(3):735–743. https://doi.org/10.1007/s12028-022-01545-9.
Crossref Google Scholar
Brain Hemorrhages
Volume 5 Issue 2,
April 2024
Pages 85-90
DOI: 10.1016/j.hest.2023.11.007
Cite this article:
Nishii R, Ohta T, Fukui N, et al. A high cardiothoracic ratio increases the risk of severe pulmonary complications after early initiation of clazosentan in patients with aneurysmal subarachnoid hemorrhage. Brain Hemorrhages, 2024, 5(2): 85-90. https://doi.org/10.1016/j.hest.2023.11.007

143

Views

0

Downloads

3

Crossref

2

Web of Science

3

Scopus

Altmetrics
Received: 25 September 2023
Revised: 30 October 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/).
Return