Clinical factors associated with delayed ischemic and non-ischemic adverse events in clazosentan therapy after aneurysmal subarachnoid hemorrhage : early insights from a multicenter prospective registry

Sugiyama, Taku; Hokari, Masaaki; Shimbo, Daisuke et al.

Neurosurgical review, 2025, 48(1), 482

Permalink : https://hdl.handle.net/2115/97908

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論文情報

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アクセス権
open access
URI
https://hdl.handle.net/2115/97908
タイトル
Clinical factors associated with delayed ischemic and non-ischemic adverse events in clazosentan therapy after aneurysmal subarachnoid hemorrhage : early insights from a multicenter prospective registry
著者
Sugiyama, Taku ; Hokari, Masaaki ; Shimbo, Daisuke ; Uchino, Haruto ; Shimoda, Yusuke ; Okamoto, Michinari ; Ito, Yasuhiro ; Gekka, Masayuki ; Saito, Hisayasu ; Yamamoto, Taiji ; Fujiwara, Yusuke ; Fujimura, Miki
e-Rad_Researcher
70748863
著者名
Sugiyama, Taku
著者名
Hokari, Masaaki
著者名
Shimbo, Daisuke
e-Rad_Researcher
40775144
著者名
Uchino, Haruto
著者名
Shimoda, Yusuke
著者名
Okamoto, Michinari
著者名
Ito, Yasuhiro
著者名
Gekka, Masayuki
著者名
Saito, Hisayasu
著者名
Yamamoto, Taiji
著者名
Fujiwara, Yusuke
e-Rad_Researcher
00361098
著者名
Fujimura, Miki
言語
英語
キーワード
DCI
Endothelin
Fluid retention
Vasodilator
Vasospasm
Pulmonary complication
発行日
2025-06-05
出版者
Springer
収録物名
Neurosurgical review
巻(号)
48(1)
ページ
482
抄録
Clazosentan (CLZ) therapy prevents delayed ischemia following aneurysmal subarachnoid hemorrhage (aSAH), but non-ischemic adverse events necessitate optimized protocols. This study presents outcomes of contemporary CLZ therapy under a unified protocol and identifies factors influencing delayed ischemic and non-ischemic adverse events following aSAH. This multicenter prospective registry analyzed data from 80 aSAH patients receiving CLZ therapy (April 2023 - October 2024). Primary endpoints were delayed ischemic events and non-ischemic adverse events; secondary endpoint was favorable outcome (modified Rankin Scale 0-2) at discharge or six weeks post-onset. Delayed ischemic events occurred in 19 patients (23.8%), including delayed ischemic neurological deterioration (8.8%), moderate-to-severe cerebral vasospasm (20.0%), and symptomatic delayed cerebral infarction (7.5%). Non-ischemic adverse events were observed in 22 patients (27.5%). Favorable outcomes were achieved in 52 patients (65.0%). Delayed ischemic events were associated with female sex, poor severity grades, higher Fischer scale scores, and elevated neutrophil-to-lymphocyte ratios. Non-ischemic adverse events were associated with older age, anemia, hypoproteinemia, and elevated cardiothoracic ratios. Multivariate analysis identified non-ischemic adverse events as significant for unfavorable outcomes (FDR p <.001), whereas delayed ischemic events were not (FDR p =.705). Among non-ischemic adverse events, pulmonary edema was the strongest factor associated with unfavorable outcomes. In conclusion, CLZ therapy with appropriate candidate selection and management protocol appears promising as a treatment option to prevent delayed ischemia after aSAH, though potential confounders warrant careful consideration. Addressing clinical risk factors for non-ischemic adverse events may further enhance treatment outcomes.
資源タイプ
学術雑誌論文
出版タイプ
Accepted Manuscript
権利情報
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s10143-025-03646-3
PISSN
0344-5607
EISSN
1437-2320
関連情報
PMID
40471403
関連情報 (isVersionOf)
出版社版DOI
https://doi.org/10.1007/s10143-025-03646-3