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Research Article | Open Access

Initial results of clazosentan with multiple-drug management for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Tatsuki Kimura, Kaima Suzuki( ), Hiroki Sato, Aoto Shibata, Yushiro Take, Hidetoshi Ooigawa, Masataka Yoshimura, Shinya Kohyama, Hiroki Kurita
Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Japan
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Abstract

Objective

Cerebral vasospasm is an unelucidated complication of subarachnoid hemorrhage. Various treatments exist against cerebral vasospasms however, consensus on the optimal treatment is lacking. We use clazosentan, which is used to prevent cerebral vasospasm, with multidrug combinations. In this study, we aimed to clarify the initial results of using clazosentan in multidrug combinations in the real world.

Methods

We retrospectively investigated 54 patients who were treated for subarachnoid hemorrhage and received clazosentan. We compared the results of these patients on the basis of two groups: those with good outcomes (modified Rankin scale score: 0–3) and poor outcomes (4–6) at discharge.

Results

Among the patients, poor outcome was observed in 19 patients (35.2 %). Angiographic vasospasms occurred in 10 patients (good outcome [n = 6] vs. poor outcome [n = 4]; p = 0.73), and symptomatic vasospasms occurred in 4 patients (n = 2 vs. n = 2, p = 0.61). The incidence of pleural effusion (28.6 % vs. 73.7 %, p < 0.01) and the mean daily fluid balance (303.5 mL/day vs. 785.4 mL/day, p < 0.01) were higher in the poor outcome group.

Conclusion

Pleural effusion and high positive balance may be associated with poor outcome. However, the number of cases examined was small; therefore, further large-scale studies with a bigger sample size are needed.

Keywords

Subarachnoid hemorrhageAngiographic vasospasmSymptomatic vasospasmClazosentanPulmonary edemaPleural effusion

References

1

Güresir E, Welchowski T, Lampmann T, et al. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: the results of induced hypertension only after the IMCVS Trial-A Prospective Cohort Study. J Clin Med.. 2022;11(19):5850. https://doi.org/10.3390/jcm11195850.
Crossref Google Scholar
2

Mijiti M, Mijiti P, Axier A, et al. Incidence and predictors of angiographic vasospasm, symptomatic vasospasm and cerebral infarction in Chinese patients with aneurysmal subarachnoid hemorrhage. PLoS One. 2016;11(12):e0168657.
Crossref Google Scholar
3

Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40(6):1963–1968. https://doi.org/10.1161/STROKEAHA.108.544700.
Crossref Google Scholar
4

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
5
Qureshi AI, Suri MF, Sung GY, et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery. 2002;50(4):749-755; discussion 755-756. doi: 10.1097/00006123-200204000-00012.
Crossref
6

Kapoor A, Dhandapani S, Gaudihalli S, et al. Serum albumin level in spontaneous subarachnoid haemorrhage: More than a mere nutritional marker! Br J Neurosurg.. 2018;32(1):47–52. https://doi.org/10.1080/02688697.2017.1344615.
Crossref Google Scholar
7

Sadamasa N, Yoshida K, Narumi O, et al. Prediction of mortality by hematological parameters on admission in patients with subarachnoid hemorrhage. Neurol Med Chir (tokyo).. 2011;51(11):745–748. https://doi.org/10.2176/nmc.51.745.
Crossref Google Scholar
8

Satoh A, Sugiyama T, Ooigawa H, et al. Prevention of symptomatic vasospasm by continuous cisternal irrigation with mock-CSF containing ascorbic acid and Mg (2+). Acta Neurochir Suppl.. 2010;107:115–118. https://doi.org/10.1007/978-3-211-99373-6_19.
Crossref Google Scholar
9

Zhao J, Zhou D, Guo J, et al. Effect of fasudil hydrochloride, a protein kinase inhibitor, on cerebral vasospasm and delayed cerebral ischemic symptoms after aneurysmal subarachnoid hemorrhage. Neurol Med Chir (tokyo).. 2006;46(9):421–428. https://doi.org/10.2176/nmc.46.421.
Crossref Google Scholar
10

Shibuya M, Suzuki Y, Sugita K, et al. Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebocontrolled double-blind trial. J Neurosurg.. 1992;76(4):571–577. https://doi.org/10.3171/jns.1992.76.4.0571.
Crossref Google Scholar
11

Tokiyoshi K, Ohnishi T, Nii Y. Efficacy and toxicity of thromboxane synthetase inhibitor for cerebral vasospasm after subarachnoid hemorrhage. Surg Neurol.. 1991;36(2):112–118. https://doi.org/10.1016/0090-3019(91)90228-2.
Crossref Google Scholar
12

Matsuda N, Naraoka M, Ohkuma H, et al. Effect of cilostazol on cerebral vasospasm and outcome in patients with aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled trial. Cerebrovasc Dis.. 2016;42(1–2):97–105. https://doi.org/10.1159/000445509.
Crossref Google Scholar
13

Sanchez-Peña P, Nouet A, Clarençon F, et al. Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: a comparative study. Crit Care Med.. 2012;40(2):594–602. https://doi.org/10.1097/CCM.0b013e31822f05e7.
Crossref Google Scholar
14

Yamamoto T, Mori K, Esaki T, et al. Preventive effect of continuous cisternal irrigation with magnesium sulfate solution on angiographic cerebral vasospasms associated with aneurysmal subarachnoid hemorrhages: a randomized controlled trial. J Neurosurg.. 2016;124(1):18–26. https://doi.org/10.3171/2015.1.JNS142757.
Crossref Google Scholar
15

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
16

Vergouwen MD, Algra A, Rinkel GJ. Endothelin receptor antagonists for aneurysmal subarachnoid hemorrhage: a systematic review and metaanalysis update. Stroke. 2012;43(10):2671–2676. https://doi.org/10.1161/STROKEAHA.112.666693.
Crossref Google Scholar
17

Shen J, Pan JW, Fan ZX, et al. Dissociation of vasospasm-related morbidity and outcomes in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: a meta-analysis of randomized controlled trials. J Neurosurg.. 2013;119(1):180–189. https://doi.org/10.3171/2013.3.JNS121436.
Crossref Google Scholar
18

Wang X, Li YM, Li WQ, et al. Effect of clazosentan in patients with aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials. PLoS One. 2012;7(10):e47778.
Crossref Google Scholar
19

Eagles ME, Tso MK, Macdonald RL. Significance of fluctuations in serum sodium levels following aneurysmal subarachnoid hemorrhage: an exploratory analysis. J Neurosurg.. 2018;131(2):420–425. https://doi.org/10.3171/2018.3.JNS173068.
Crossref Google Scholar
20

Muraoka S, Asai T, Fukui T, et al. Real-world data of clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. Neurosurg Rev.. 2023;46(1):195. https://doi.org/10.1007/s10143-023-02104-2.
Crossref Google Scholar
21

Diringer MN, Bleck TP, Claude Hemphill J, 3rd,, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care.. 2011;15(2):211–240. https://doi.org/10.1007/s12028-011-9605-9.
Crossref Google Scholar
22

Goldberg J, Schoeni D, Mordasini P, et al. Survival and outcome after poor-grade aneurysmal subarachnoid hemorrhage in elderly patients. Stroke. 2018;49(12):2883–2889. https://doi.org/10.1161/STROKEAHA.118.022869.
Crossref Google Scholar
23

Ikawa F, Ichihara N, Uno M, et al. Visualisation of the non-linear correlation between age and poor outcome in patients with aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry.. 2021;92(11):1173–1180. https://doi.org/10.1136/jnnp-2020-325306.
Crossref Google Scholar
Brain Hemorrhages
Volume 5 Issue 2,
April 2024
Pages 79-84
DOI: 10.1016/j.hest.2024.01.004
Cite this article:
Kimura T, Suzuki K, Sato H, et al. Initial results of clazosentan with multiple-drug management for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Brain Hemorrhages, 2024, 5(2): 79-84. https://doi.org/10.1016/j.hest.2024.01.004

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Received: 18 December 2023
Revised: 17 January 2024
Accepted: 22 January 2024
Published: 26 January 2024
© 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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