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Kondo H, Ishii D, Kuwabara M, Hara T, Kurisu K, Sumida M, Ikawa F, Ohba S, Tominaga A, Obayashi N, Kuroki K, Sadatomo T, Hamasaki O, Sakamoto S, Matsushige T, Watanabe Y, Araki H, Abiko M, Ichinose N, Takenobu A, Horie N. Multicenter Validation of a Unified Evidence-Based Treatment Protocol Focusing on Clazosentan for Managing Subarachnoid Hemorrhage. J Clin Med 2025; 14:3423. [PMID: 40429418 PMCID: PMC12112021 DOI: 10.3390/jcm14103423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 05/04/2025] [Accepted: 05/09/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Effective management of aneurysmal subarachnoid hemorrhage (aSAH) requires an evidence-based treatment protocol. This study examines the outcomes of a unified, multicenter protocol emphasizing postoperative clazosentan as the first-line treatment for vasospasm. Methods: A standardized protocol prioritizing systemic management with clazosentan for vasospasm was implemented in April 2023. Cases treated between April 2022 and March 2024 were categorized into four groups: preprotocol fasudil treatment (PrF), preprotocol clazosentan treatment (PrC), postprotocol fasudil treatment (PoF), and postprotocol clazosentan treatment (PoC); these groups were analyzed. Results: Among 407 registered cases, 322 were eligible for analysis (PrF, 128; PrC, 69; PoF, 28; PoC, 97). PoC exhibited significantly lower angiographic vasospasm rates and had a lower incidence of symptomatic vasospasm compared with PrF (p = 0.048, p = 0.057). Logistic regression identified the clazosentan protocol as a predictive factor for vasospasm reduction (p = 0.02, OR 0.46 [0.22-0.94]; p = 0.022, OR 0.38 [0.16-0.91]). PoC experienced less fluid retention than the PrC (p < 0.001). Logistic regression confirmed protocol adherence with protocol reduced complications (p < 0.001, OR 0.24 [0.11-0.52]), included fluid retention (p < 0.001, OR 0.088 [0.03-0.29]). In older patients, no significant differences in vasospasm or complications were observed between PrF and PoC, but a trend toward reduced complications was observed in World Federation of Neurosurgical Societies (WFNS) grade V cases. Conclusions: Clazosentan-first protocol effectively reduces vasospasm and complications in aSAH management. It is also safe for older patients and those with WFNS grade V, offering a promising treatment strategy.
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Affiliation(s)
- Hiroshi Kondo
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (D.I.); (M.K.); (T.H.); (N.H.)
- Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan;
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (D.I.); (M.K.); (T.H.); (N.H.)
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (D.I.); (M.K.); (T.H.); (N.H.)
| | - Takeshi Hara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (D.I.); (M.K.); (T.H.); (N.H.)
| | | | - Masayuki Sumida
- Department of Neurosurgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima 730-8619, Japan;
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo 693-8555, Japan;
| | - Shinji Ohba
- Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan;
| | - Atsushi Tominaga
- Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan;
| | - Naohiko Obayashi
- Department of Neurosurgery, Matsue Red Cross Hospital, Matsue 690-8506, Japan;
| | - Kazuhiko Kuroki
- Department of Neurosurgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Japan;
| | - Takashi Sadatomo
- Department of Neurosurgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima 739-0041, Japan;
| | - Osamu Hamasaki
- Department of Neurosurgery, Miyoshi Central Hospital, Miyoshi 728-8502, Japan;
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Itsukaichi Memorial Hospital, Itsukaichi 731-5156, Japan;
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan;
| | - Yosuke Watanabe
- Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama 790-8524, Japan;
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima 733-0821, Japan;
| | - Masaru Abiko
- Department of Neurosurgery, JA Onomichi General Hospital, Onomichi 722-8508, Japan;
| | - Nobuhiko Ichinose
- Department of Neurosurgery, Ichinose Hospital, Hiroshima 730-0042, Japan
| | - Atsumi Takenobu
- Department of Neurosurgery, Teraoka Memorial Hospital, Fukuyama 729-3103, Japan;
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (D.I.); (M.K.); (T.H.); (N.H.)
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