Efficacy of combined clazosentan and cilostazol therapy for cerebral vasospasm after subarachnoid hemorrhage: a retrospective multicenter registry study.

IF 3.6 2区 医学 Q1 CLINICAL NEUROLOGY
Issei Takeuchi, Shinsuke Muraoka, Fumie Kinoshita, Takashi Izumi, Kazuki Ishii, Masahiro Nishihori, Shunsaku Goto, Ryuta Saito
{"title":"Efficacy of combined clazosentan and cilostazol therapy for cerebral vasospasm after subarachnoid hemorrhage: a retrospective multicenter registry study.","authors":"Issei Takeuchi, Shinsuke Muraoka, Fumie Kinoshita, Takashi Izumi, Kazuki Ishii, Masahiro Nishihori, Shunsaku Goto, Ryuta Saito","doi":"10.3171/2025.5.JNS243007","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poor prognosis. Since 2022, clazosentan has become available for clinical use in Japan and has shown potential in improving clinical outcomes for patients with aSAH. However, whether clazosentan alone is sufficient to achieve optimal results or combination therapy is required remains unclear. In this study, the authors aimed to assess the efficacy of combining clazosentan and cilostazol for treating cerebral vasospasm following aSAH due to a ruptured cerebral aneurysm.</p><p><strong>Methods: </strong>This retrospective multicenter study was conducted using repository data from April 2023 to March 2024 from across 20 institutes. Patients who underwent coil embolization or surgical clipping within 48 hours of aSAH and had a preoperative modified Rankin Scale (mRS) score of 0-2 were eligible for inclusion in the study. Patients who received clazosentan plus fasudil were excluded. The patients were divided into two groups: those who received clazosentan plus cilostazol (cilostazol combination group) and those who did not receive cilostazol (noncilostazol group). Outcomes were measured based on discharge mRS scores (primary) and complications (secondary), including cerebral vasospasm, delayed cerebral ischemia (DCI), pulmonary complications, hypotension, cerebral edema, and de novo intracranial hemorrhage.</p><p><strong>Results: </strong>In total, 161 patients were included in this study, with 94 and 67 patients in the cilostazol combination and noncilostazol groups, respectively. No significant difference was observed between the two groups in terms of optimal outcomes at discharge (mRS score 0-2). However, the cilostazol combination group tended to experience a lower rate of poor outcomes than the noncilostazol group (11.7% vs 14.9%, respectively, OR 0.36, 95% CI 0.11-1.2, p = 0.095). The incidence rate of DCI was significantly lower in the cilostazol combination group than in the noncilostazol group (0.0% vs 7.5%, p = 0.02). No significant differences were found between the two groups with respect to other complications.</p><p><strong>Conclusions: </strong>The combination of clazosentan and cilostazol may reduce the incidence of DCI, although its impact on functional outcomes remains unclear. Further research is warranted to explore effective pharmacological strategies for improving the prognosis of aSAH.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2025.5.JNS243007","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poor prognosis. Since 2022, clazosentan has become available for clinical use in Japan and has shown potential in improving clinical outcomes for patients with aSAH. However, whether clazosentan alone is sufficient to achieve optimal results or combination therapy is required remains unclear. In this study, the authors aimed to assess the efficacy of combining clazosentan and cilostazol for treating cerebral vasospasm following aSAH due to a ruptured cerebral aneurysm.

Methods: This retrospective multicenter study was conducted using repository data from April 2023 to March 2024 from across 20 institutes. Patients who underwent coil embolization or surgical clipping within 48 hours of aSAH and had a preoperative modified Rankin Scale (mRS) score of 0-2 were eligible for inclusion in the study. Patients who received clazosentan plus fasudil were excluded. The patients were divided into two groups: those who received clazosentan plus cilostazol (cilostazol combination group) and those who did not receive cilostazol (noncilostazol group). Outcomes were measured based on discharge mRS scores (primary) and complications (secondary), including cerebral vasospasm, delayed cerebral ischemia (DCI), pulmonary complications, hypotension, cerebral edema, and de novo intracranial hemorrhage.

Results: In total, 161 patients were included in this study, with 94 and 67 patients in the cilostazol combination and noncilostazol groups, respectively. No significant difference was observed between the two groups in terms of optimal outcomes at discharge (mRS score 0-2). However, the cilostazol combination group tended to experience a lower rate of poor outcomes than the noncilostazol group (11.7% vs 14.9%, respectively, OR 0.36, 95% CI 0.11-1.2, p = 0.095). The incidence rate of DCI was significantly lower in the cilostazol combination group than in the noncilostazol group (0.0% vs 7.5%, p = 0.02). No significant differences were found between the two groups with respect to other complications.

Conclusions: The combination of clazosentan and cilostazol may reduce the incidence of DCI, although its impact on functional outcomes remains unclear. Further research is warranted to explore effective pharmacological strategies for improving the prognosis of aSAH.

克拉生坦联合西洛他唑治疗蛛网膜下腔出血后脑血管痉挛的疗效:一项回顾性多中心登记研究。
目的:动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛与不良预后相关。自2022年以来,clazosentan已在日本投入临床使用,并显示出改善aSAH患者临床结果的潜力。然而,是否单独使用克唑生坦就足以达到最佳效果,还是需要联合治疗仍不清楚。在这项研究中,作者旨在评估克拉生坦和西洛他唑联合治疗脑动脉瘤破裂aSAH后脑血管痉挛的疗效。方法:采用20个研究所2023年4月至2024年3月的数据库数据进行回顾性多中心研究。aSAH患者在48小时内接受线圈栓塞或手术夹断,术前修改Rankin量表(mRS)评分为0-2分的患者符合纳入研究的条件。排除接受克拉生坦加法舒地尔治疗的患者。将患者分为两组:接受氯替森坦加西洛他唑治疗组(西洛他唑联合组)和不接受西洛他唑治疗组(非西洛他唑组)。结果根据出院mRS评分(原发性)和并发症(继发性)来衡量,包括脑血管痉挛、迟发性脑缺血(DCI)、肺部并发症、低血压、脑水肿和新生颅内出血。结果:本研究共纳入161例患者,西洛他唑联合组94例,非西洛他唑组67例。两组在出院时的最佳结果(mRS评分0-2)方面无显著差异。然而,西洛他唑联合组的不良预后率往往低于非西洛他唑组(分别为11.7%对14.9%,OR 0.36, 95% CI 0.11-1.2, p = 0.095)。西洛他唑联合组DCI发生率显著低于非西洛他唑组(0.0% vs 7.5%, p = 0.02)。两组在其他并发症方面无显著差异。结论:克唑生坦联合西洛他唑可降低DCI的发生率,但其对功能结局的影响尚不清楚。需要进一步的研究来探索改善aSAH预后的有效药理策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信