Systemic Cardiovascular Responses to Clazosentan as Potential Indicators of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage
Abstract
Background Clazosentan, an endothelin A receptor antagonist, reduces angiographic vasospasm after subarachnoid hemorrhage (SAH); however, delayed cerebral ischemia (DCI) can still develop. We investigated whether the systemic cardiovascular responses to clazosentan could predict the occurrence of DCI. Methods We retrospectively analyzed 48 patients with aneurysmal SAH treated with clazosentan. Cardiac output (CO) and systemic vascular resistance (SVR) were measured using a non-invasive finger-cuff hemodynamic monitor. Changes in CO and SVR (ΔCO and ΔSVR) were defined as differences between post- and pre-clazosentan administration. Results DCI occurred in seven patients (14.6%). Patients with DCI showed significantly lower ΔCO (-0.4 L/min vs 0.7 L/min, p = 0.014) and higher SVR (454 mmHg·min/L vs. -242 mmHg·min/L, p = 0.008) than those without DCI. Receiver operating characteristic analysis revealed an area under the curve of 0.817 (95% confidence interval (CI), 0.660–0.974) for ΔCO and 0.794 (95% CI, 0.591–0.998) for ΔSVR. In multivariate logistic regression, the combined pattern of negative ΔCO and positive ΔSVR was independently associated with DCI after age adjustment (odds ratio 11.03, 95% CI 1.34-90.75, p = 0.026). Conclusions These exploratory findings raise the possibility that non-invasive monitoring of systemic hemodynamic responses may help identify the patients at high risk of DCI after SAH during clazosentan therapy.
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BibTeX
@article{yoshimichisatomd2026systemic,
title = {{Systemic Cardiovascular Responses to Clazosentan as Potential Indicators of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage}},
author = {Yoshimichi Sato MD, PhD and Hiroyuki Sakata MD, PhD and Shinichiro Sugiyama MD, PhD and Yuto Shingai MD, PhD and Ryosuke Tashiro MD, PhD and Atsushi Kanoke MD, PhD and Hiroki Uchida MD, PhD and Shunsuke Omodaka MD, PhD and Hidenori Endo MD, PhD},
journal = {Journal of Central Nervous System Disease},
year = {2026},
month = oct,
doi = {10.1177/11795735261501436},
url = {https://doi.org/10.1177/11795735261501436},
note = {CC BY},
}
RIS
TY - JOUR
TI - Systemic Cardiovascular Responses to Clazosentan as Potential Indicators of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage
AU - Yoshimichi Sato MD, PhD
AU - Hiroyuki Sakata MD, PhD
AU - Shinichiro Sugiyama MD, PhD
AU - Yuto Shingai MD, PhD
AU - Ryosuke Tashiro MD, PhD
AU - Atsushi Kanoke MD, PhD
AU - Hiroki Uchida MD, PhD
AU - Shunsuke Omodaka MD, PhD
AU - Hidenori Endo MD, PhD
PY - 2026
DA - 2026/10/24
JO - Journal of Central Nervous System Disease
DO - 10.1177/11795735261501436
UR - https://doi.org/10.1177/11795735261501436
AB - Background Clazosentan, an endothelin A receptor antagonist, reduces angiographic vasospasm after subarachnoid hemorrhage (SAH); however, delayed cerebral ischemia (DCI) can still develop. We investigated whether the systemic cardiovascular responses to clazosentan could predict the occurrence of DCI. Methods We retrospectively analyzed 48 patients with aneurysmal SAH treated with clazosentan. Cardiac output (CO) and systemic vascular resistance (SVR) were measured using a non-invasive finger-cuff hemodynamic monitor. Changes in CO and SVR (ΔCO and ΔSVR) were defined as differences between post- and pre-clazosentan administration. Results DCI occurred in seven patients (14.6%). Patients with DCI showed significantly lower ΔCO (-0.4 L/min vs 0.7 L/min, p = 0.014) and higher SVR (454 mmHg·min/L vs. -242 mmHg·min/L, p = 0.008) than those without DCI. Receiver operating characteristic analysis revealed an area under the curve of 0.817 (95% confidence interval (CI), 0.660–0.974) for ΔCO and 0.794 (95% CI, 0.591–0.998) for ΔSVR. In multivariate logistic regression, the combined pattern of negative ΔCO and positive ΔSVR was independently associated with DCI after age adjustment (odds ratio 11.03, 95% CI 1.34-90.75, p = 0.026). Conclusions These exploratory findings raise the possibility that non-invasive monitoring of systemic hemodynamic responses may help identify the patients at high risk of DCI after SAH during clazosentan therapy.
SN - 1179-5735
ER -